=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235798596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA MISCHKE, LMHP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 N 10TH ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68508-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-730-7987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2540 S 22ND ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68502-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-730-7987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. LISA MISCHKE
-----------------------------------------------------
Credential | LMHP
-----------------------------------------------------
Telephone | 402-730-7987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------