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General NPI Number Information
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NPI Number | 1932539426
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Entity Type | Individual
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Provider Name | LILLIE LYN WEATHERALL MS, NCC, LIMHP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 3308 SAMSON WAY
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City | BELLEVUE
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State | NE
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Zip | 68123-3234
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Country | US
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Telephone | 402-598-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 7261 MERCY RD
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City | OMAHA
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State | NE
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Zip | 68124-2311
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Country | US
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Telephone | 402-598-3343
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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 | 2687
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License Number State | NE
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