Provider Demographics
NPI:1609363076
Name:PEASE, CARRIE LYNN (LMHP #5470)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:PEASE
Suffix:
Gender:F
Credentials:LMHP #5470
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 S 215TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2046
Mailing Address - Country:US
Mailing Address - Phone:402-350-1552
Mailing Address - Fax:
Practice Address - Street 1:17940 WELCH PLZ STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3714
Practice Address - Country:US
Practice Address - Phone:402-350-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health