Healthcare Provider Details

I. General information

NPI: 1598644122
Provider Name (Legal Business Name): NATALIE MUNDT WALDRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W 2ND ST
ALLIANCE NE
69301-3766
US

IV. Provider business mailing address

224 W 2ND ST
ALLIANCE NE
69301-3766
US

V. Phone/Fax

Practice location:
  • Phone: 308-225-6167
  • Fax: 308-275-2042
Mailing address:
  • Phone: 308-225-6167
  • Fax: 308-275-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2641
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: