Provider Demographics
NPI:1730609249
Name:ISRAELSON, CARLI (PLMHP)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:ISRAELSON
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 1:3100 O ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1532
Mailing Address - Country:US
Mailing Address - Phone:402-261-5048
Mailing Address - Fax:
Practice Address - Street 1:3100 O ST STE 7
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1532
Practice Address - Country:US
Practice Address - Phone:402-261-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health