Healthcare Provider Details

I. General information

NPI: 1225177652
Provider Name (Legal Business Name): BRENDA HIEBNER LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 LAKE AVE
GOTHENBURG NE
69138
US

IV. Provider business mailing address

1512 AVENUE G
GOTHENBURG NE
69138-1716
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-3691
  • Fax: 308-537-3062
Mailing address:
  • Phone: 308-537-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number582
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2162
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: