MEDICARE: ERIC RODNEY HENNING M.A.

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	8534	NE

General Provider Information

NPI Number	:	1609044593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC RODNEY HENNING M.A.

Provider Business Mailing Address
First Line	:	PO BOX 53
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68702-0053
Country	:	US
Telephone Number	:	402-371-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 N 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2591
Country	:	US
Telephone Number	:	402-371-8218
Fax Number	:

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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