Provider Demographics
NPI:1285178087
Name:TIA NORDYKE, MA, LIMHP
Entity type:Organization
Organization Name:TIA NORDYKE, MA, LIMHP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMHP
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NORDYKE KING
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:402-309-3892
Mailing Address - Street 1:5630 S 84TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4470
Mailing Address - Country:US
Mailing Address - Phone:402-309-3892
Mailing Address - Fax:
Practice Address - Street 1:5630 S 84TH ST STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4470
Practice Address - Country:US
Practice Address - Phone:402-309-3892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE48027OtherBCBS OF NEBRASKA
NE10025867800Medicaid
NE233141OtherMIDLANDS CHOICE