Healthcare Provider Details

I. General information

NPI: 1346325925
Provider Name (Legal Business Name): LORI P. WILES LIMHP, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 MAIN ST STE 259
RALSTON NE
68127-5903
US

IV. Provider business mailing address

1703 LAKEWOOD DR
PAPILLION NE
68046-4297
US

V. Phone/Fax

Practice location:
  • Phone: 402-699-3468
  • Fax:
Mailing address:
  • Phone: 402-699-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number710
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: