Provider Demographics
NPI:1962612796
Name:STUTZMAN, MELISSA SUE (LMHP, PLADC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUE
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:LMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405-0327
Mailing Address - Country:US
Mailing Address - Phone:402-440-3055
Mailing Address - Fax:
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-440-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-591101YA0400X
NE3070101YM0800X
NE1592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025568100Medicaid
NE84626OtherBCBS
NE251697OtherMIDLANDS CHOICE
NE34568000OtherMAGELLAN MANAGED CARE
NE47075636930Medicaid