Healthcare Provider Details

I. General information

NPI: 1346465192
Provider Name (Legal Business Name): BETH LYNN EHRISMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 E 32ND AVE
COLUMBUS NE
68601-7233
US

IV. Provider business mailing address

110 PAR ACRES RD
BEEMER NE
68716-4073
US

V. Phone/Fax

Practice location:
  • Phone: 402-562-7500
  • Fax:
Mailing address:
  • Phone: 402-528-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8104
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: