Healthcare Provider Details

I. General information

NPI: 1114599610
Provider Name (Legal Business Name): LACY J DYE LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 20TH ST
GOTHENBURG NE
69138-1253
US

IV. Provider business mailing address

PO BOX 469
GOTHENBURG NE
69138-0469
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-3661
  • Fax: 308-537-3074
Mailing address:
  • Phone: 308-537-3661
  • Fax: 308-537-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4012
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: