MEDICARE: BRYANNA DOUGHTY

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	13228	NE

General Provider Information

NPI Number	:	1346940855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANNA DOUGHTY

Provider Business Mailing Address
First Line	:	1501 CHEYENNE ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68502-4724
Country	:	US
Telephone Number	:	304-261-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 N 62ND ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68507-1227
Country	:	US
Telephone Number	:	304-261-4519
Fax Number	:

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

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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Directions to “ BRYANNA DOUGHTY ” Practice Location

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