Healthcare Provider Details

I. General information

NPI: 1508210642
Provider Name (Legal Business Name): MICHELLE ANN WOOTEN LIMHP, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 70TH ST STE 200
LINCOLN NE
68506-1568
US

IV. Provider business mailing address

12019 S 79TH AVE
PAPILLION NE
68046-4609
US

V. Phone/Fax

Practice location:
  • Phone: 402-309-4487
  • Fax: 402-937-8324
Mailing address:
  • Phone: 402-309-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10823
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2394
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: