Healthcare Provider Details

I. General information

NPI: 1265215529
Provider Name (Legal Business Name): PAOLA CARRILLO-LAZALDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NORMAL BLVD STE 201
LINCOLN NE
68506-5250
US

IV. Provider business mailing address

1123 N 9TH ST
BEATRICE NE
68310-2041
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-4017
  • Fax:
Mailing address:
  • Phone: 402-228-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: