Provider Demographics
NPI:1801296660
Name:LAURELL, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LAURELL
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 1:3701 UNION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6629
Mailing Address - Country:US
Mailing Address - Phone:402-875-9270
Mailing Address - Fax:402-875-9272
Practice Address - Street 1:3701 UNION DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6629
Practice Address - Country:US
Practice Address - Phone:402-875-9270
Practice Address - Fax:402-875-9272
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health