MEDICARE: MRS. RANDI YVONNE BIBINS-CLARK LMHP, PMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3218	NE

General Provider Information

NPI Number	:	1184829103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RANDI YVONNE BIBINS-CLARK LMHP, PMSW

Provider Business Mailing Address
First Line	:	8438 BAKER ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68122-1265
Country	:	US
Telephone Number	:	402-573-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002A WENNINGHOFF RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1903
Country	:	US
Telephone Number	:	402-850-5387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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