MEDICARE: CHRISTINE HENNIG MA, LMHP

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	4164	NE

General Provider Information

NPI Number	:	1639416217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE HENNIG MA, LMHP

Provider Business Mailing Address
First Line	:	11907 ARBOR ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-3002
Country	:	US
Telephone Number	:	402-517-1504
Fax Number	:

Provider Business Practice Location Address
First Line	:	11907 ARBOR ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-3002
Country	:	US
Telephone Number	:	402-517-1504
Fax Number	:

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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