=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003155482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUSTIN LEE HANNEMANN LIMHP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2013
-----------------------------------------------------
Last Update Date | 10/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 Q ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68508-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-913-4999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 LINCOLN ST
-----------------------------------------------------
City | SEWARD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68434-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-913-4999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1028
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------