Healthcare Provider Details

I. General information

NPI: 1174257794
Provider Name (Legal Business Name): NOELLE HEFFLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1933 BOSTON CIR
LINCOLN NE
68521-1557
US

IV. Provider business mailing address

PO BOX 1927
KELLER TX
76244-1927
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-0108
  • Fax:
Mailing address:
  • Phone: 402-937-0108
  • Fax: 402-387-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13046
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: