MEDICARE: WEST MAPLE COUNSELING ASSOCIATES

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	1406	NE

General Provider Information

NPI Number	:	1609328475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST MAPLE COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	2511 N 73RD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-6802
Country	:	US
Telephone Number	:	402-393-0133
Fax Number	:	402-391-0498

Provider Business Practice Location Address
First Line	:	2511 N 73RD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-6802
Country	:	US
Telephone Number	:	402-393-0133
Fax Number	:	402-391-0498

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	LISA VOGEL
Credential	:	LIMHP
Telephone Number	:	402-393-0133

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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