MEDICARE: MRS. CASSI CORINN WIGINGTON PLMHP, NCC

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	8694	NE

General Provider Information

NPI Number	:	1225285836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSI CORINN WIGINGTON PLMHP, NCC

Provider Business Mailing Address
First Line	:	13057 W CENTER RD
Second Line	:	SUITE 25
City	:	OMAHA
State	:	NE
Zip	:	68144-3748
Country	:	US
Telephone Number	:	402-333-7502
Fax Number	:	402-333-7504

Provider Business Practice Location Address
First Line	:	13057 W CENTER RD
Second Line	:	SUITE 25
City	:	OMAHA
State	:	NE
Zip	:	68144-3748
Country	:	US
Telephone Number	:	402-333-7502
Fax Number	:	402-333-7504

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	09/18/2008

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