=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144577230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE WORLD HEALING INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2012
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 285 S 68TH STREET PL STE 318
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-2586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-525-7509
-----------------------------------------------------
Fax | 402-323-3399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 285 S 68TH STREET PL STE 318
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-2586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-525-7509
-----------------------------------------------------
Fax | 402-323-3399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MARY LOUISE SIMBARCELOS
-----------------------------------------------------
Credential | M.S., LIMHP, LADC
-----------------------------------------------------
Telephone | 402-525-7509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 405
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1799
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------