MEDICARE: MICHELLE ANN WOOTEN LIMHP, CPC

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	10823	NE
2	101YM0800X	Mental Health Counselor	2394	NE

General Provider Information

NPI Number	:	1508210642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANN WOOTEN LIMHP, CPC

Provider Business Mailing Address
First Line	:	12019 S 79TH AVE
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-4609
Country	:	US
Telephone Number	:	402-309-4487
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S 70TH ST STE 200
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-1568
Country	:	US
Telephone Number	:	402-309-4487
Fax Number	:	402-937-8324

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

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	05/18/2020

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