Provider Demographics
NPI:1437217353
Name:ZLOMKE, LISE ANNE (LIMHP, CPC, LPC)
Entity type:Individual
Prefix:MS
First Name:LISE
Middle Name:ANNE
Last Name:ZLOMKE
Suffix:
Gender:F
Credentials:LIMHP, CPC, LPC
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 2078
Mailing Address - Street 2:100 EAST 5TH STREET; SUITE 203
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3924
Mailing Address - Country:US
Mailing Address - Phone:308-532-2335
Mailing Address - Fax:308-532-4806
Practice Address - Street 1:100 EAST 5TH STREET; SUITE 203
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3924
Practice Address - Country:US
Practice Address - Phone:308-532-2335
Practice Address - Fax:308-532-4806
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025317500Medicaid