Provider Demographics
NPI:1063127389
Name:MATHIS, MELISSA ANNE (PLMHP, PLMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PLMHP, PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 COLT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1109
Mailing Address - Country:US
Mailing Address - Phone:402-805-7048
Mailing Address - Fax:
Practice Address - Street 1:4316 S 48TH ST STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1287
Practice Address - Country:US
Practice Address - Phone:402-991-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78181041C0700X
NE13281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical