Provider Demographics
NPI:1699286971
Name:MURPHY, EDANNE LYNN
Entity type:Individual
Prefix:
First Name:EDANNE
Middle Name:LYNN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDANNE
Other - Middle Name:LYNN
Other - Last Name:QUALSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP
Mailing Address - Street 1:12954 MARGO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-6024
Mailing Address - Country:US
Mailing Address - Phone:402-810-2642
Mailing Address - Fax:
Practice Address - Street 1:509 W SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1705
Practice Address - Country:US
Practice Address - Phone:712-520-0237
Practice Address - Fax:866-675-5954
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health