Healthcare Provider Details

I. General information

NPI: 1003842568
Provider Name (Legal Business Name): DIANA M MEADORS LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S 205TH ST
ELKHORN NE
68022-2141
US

IV. Provider business mailing address

540 S 205TH ST
ELKHORN NE
68022-2141
US

V. Phone/Fax

Practice location:
  • Phone: 402-601-1362
  • Fax:
Mailing address:
  • Phone: 402-601-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number809
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number960
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number809
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: