Provider Demographics
NPI:1588063341
Name:HARROLD, SUE
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HARROLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 O ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1510
Mailing Address - Country:US
Mailing Address - Phone:402-742-9616
Mailing Address - Fax:402-742-9116
Practice Address - Street 1:3200 O ST STE 5
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1510
Practice Address - Country:US
Practice Address - Phone:402-742-9616
Practice Address - Fax:402-742-9116
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)