Healthcare Provider Details

I. General information

NPI: 1003070376
Provider Name (Legal Business Name): TRACY J WEILAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N ERIE ST
LEXINGTON NE
68850-1560
US

IV. Provider business mailing address

1201 N ERIE ST
LEXINGTON NE
68850-1560
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-5651
  • Fax:
Mailing address:
  • Phone: 308-324-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8598
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1498
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4232
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: