Provider Demographics
NPI:1588740534
Name:WOODRUFF, LAURALEE
Entity type:Individual
Prefix:MRS
First Name:LAURALEE
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURALEE
Other - Middle Name:
Other - Last Name:CLINCHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHP, LIMHP
Mailing Address - Street 1:1919 SOUTH 40TH STREET
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-475-5069
Mailing Address - Fax:402-475-2350
Practice Address - Street 1:1919 SOUTH 40TH STREET
Practice Address - Street 2:SUITE 312
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-475-5069
Practice Address - Fax:402-475-2350
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELIMHP # 1211101YM0800X
NELMHP # 2729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85296OtherBLUE CROSS & BLUE SHIELD