Provider Demographics
NPI:1588968986
Name:CARVILLE, MISTY RACHELLE (LIMHP, LADC, NCC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:RACHELLE
Last Name:CARVILLE
Suffix:
Gender:F
Credentials:LIMHP, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 68TH STREET PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2475
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:300 S 68TH STREET PL
Practice Address - Street 2:SUITE 500
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2475
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-434-3970
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1053101YA0400X
NE1215101YM0800X, 101YM0800X
NE4119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075636930Medicaid