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General NPI Number Information
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NPI Number | 1821411778
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Entity Type | Individual
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Provider Name | MINDI JO MCEWEN-HAYNES PLMHP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 224 N MAIN ST STE 2
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City | FREMONT
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State | NE
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Zip | 68025-5693
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Country | US
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Telephone | 402-541-5572
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Fax |
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Provider Business Mailing Address
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Address Line | 524 S 188TH AVENUE CIR
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City | ELKHORN
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State | NE
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Zip | 68022-5642
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Country | US
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Telephone | 402-763-9080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10168
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License Number State | NE
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