=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649764234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA ANDRES LIMHP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2018
-----------------------------------------------------
Last Update Date | 03/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14092 HOSPITAL RD
-----------------------------------------------------
City | BOYS TOWN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-355-5226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6820 S 49TH ST
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68117-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-355-5226
-----------------------------------------------------
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 | 1978
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------