Provider Demographics
NPI:1447540786
Name:ARNETT NICKOLAUS, THERESA (MAC LIMHP CIMHP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ARNETT NICKOLAUS
Suffix:
Gender:F
Credentials:MAC LIMHP CIMHP
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 111
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-0111
Mailing Address - Country:US
Mailing Address - Phone:402-631-7267
Mailing Address - Fax:
Practice Address - Street 1:616 13TH ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2426
Practice Address - Country:US
Practice Address - Phone:402-631-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1520101YA0400X
NE9315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026546100Medicaid