=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033480785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ROGER AVEYARD, LIMHP, CPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2012
-----------------------------------------------------
Last Update Date | 01/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1216 S 8TH ST
-----------------------------------------------------
City | BEATRICE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68310-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-496-9966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1216 S 8TH ST
-----------------------------------------------------
City | BEATRICE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68310-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROGER AVEYARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-496-9966
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 518
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------