MEDICARE: EMILY GOODMAN LIMHP, LMHP, LADC,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1948	NE
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1203	NE

General Provider Information

NPI Number	:	1073979514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GOODMAN LIMHP, LMHP, LADC,

Provider Business Mailing Address
First Line	:	14620 CAVALIER ST
Second Line	:
City	:	WAVERLY
State	:	NE
Zip	:	68462-1649
Country	:	US
Telephone Number	:	402-560-4156
Fax Number	:	402-267-4656

Provider Business Practice Location Address
First Line	:	701 P ST STE 303
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68508-1356
Country	:	US
Telephone Number	:	402-560-4156
Fax Number	:	402-267-4656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	02/02/2023

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