MEDICARE: HAILEY MARISSA PIERCE

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	12869	NE

General Provider Information

NPI Number	:	1497407597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY MARISSA PIERCE

Provider Business Mailing Address
First Line	:	11218 JOHN GALT BLVD STE 204
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-2358
Country	:	US
Telephone Number	:	402-506-9254
Fax Number	:	620-820-7643

Provider Business Practice Location Address
First Line	:	11218 JOHN GALT BLVD STE 204
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-2358
Country	:	US
Telephone Number	:	402-506-9254
Fax Number	:	620-820-7643

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

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	01/20/2022

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Directions to “ HAILEY MARISSA PIERCE ” Practice Location

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