Provider Demographics
NPI:1023276102
Name:ELKOVITCH, NATASHA C (PLMHP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:C
Last Name:ELKOVITCH
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 VALLEY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4844
Mailing Address - Country:US
Mailing Address - Phone:402-483-4571
Mailing Address - Fax:402-483-5079
Practice Address - Street 1:4600 VALLEY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4844
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:402-483-5079
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301101Medicaid