Provider Demographics
NPI:1285852350
Name:DUDLEY, MICHELE L (MS, LMHP, LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MS, LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 PACIFIC ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5405
Mailing Address - Country:US
Mailing Address - Phone:402-651-3860
Mailing Address - Fax:
Practice Address - Street 1:7602 PACIFIC ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5405
Practice Address - Country:US
Practice Address - Phone:402-651-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NE3703101YM0800X
NE7945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025485800Medicaid