=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437217353
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISE ANNE ZLOMKE LIMHP, CPC, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 EAST 5TH STREET; SUITE 203
-----------------------------------------------------
City | NORTH PLATTE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69101-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-532-2335
-----------------------------------------------------
Fax | 308-532-4806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2078 100 EAST 5TH STREET; SUITE 203
-----------------------------------------------------
City | NORTH PLATTE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69101-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-532-2335
-----------------------------------------------------
Fax | 308-532-4806
-----------------------------------------------------
=====================================================
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 | 447
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------