Individual
MS. ELISA LYNN FORDYCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLMHP
Contact information
Practice address
5115 F ST, OMAHA, NE 68117-2807
(402) 397-9866
(402) 397-1404
Mailing address
17851 MARGO ST, OMAHA, NE 68136-2093
(402) 990-5796
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9164
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470765107
—
NE
Enumeration date
09/27/2010
Last updated
09/27/2010
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