Provider Demographics
NPI:1215276068
Name:BURSOVSKY, NICOLE CHANEY (LIMHP, LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHANEY
Last Name:BURSOVSKY
Suffix:
Gender:F
Credentials:LIMHP, LPC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CHANEY
Other - Last Name:KAUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6911 VAN DORN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6801
Mailing Address - Country:US
Mailing Address - Phone:308-920-2223
Mailing Address - Fax:531-249-5886
Practice Address - Street 1:6911 VAN DORN ST STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6801
Practice Address - Country:US
Practice Address - Phone:308-920-2223
Practice Address - Fax:531-249-5886
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4471101YM0800X
NE2175101YP2500X
NE2662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty