Provider Demographics
NPI:1285716449
Name:SIECK, ELISHA ANN (LMHP)
Entity type:Individual
Prefix:MRS
First Name:ELISHA
Middle Name:ANN
Last Name:SIECK
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 NORMAL BLVD
Mailing Address - Street 2:SUITE 262
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5576
Mailing Address - Country:US
Mailing Address - Phone:402-499-3880
Mailing Address - Fax:402-327-9746
Practice Address - Street 1:4535 NORMAL BLVD
Practice Address - Street 2:SUITE 262
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5576
Practice Address - Country:US
Practice Address - Phone:402-499-3880
Practice Address - Fax:402-327-9746
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025153500Medicaid
NE85207OtherBCBS OF NE PROVIDER #