=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295882892
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH WAYNE CHANDLER M.S., LMHP, CPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 S 40TH ST SUITE 111
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-488-6760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1627 S COTNER BLVD
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-488-7535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1123
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------