MEDICARE: PANDO GERIATRIC COUNSELING, PC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700171741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANDO GERIATRIC COUNSELING, PC

Provider Business Mailing Address
First Line	:	10806 PRAIRIE HILLS DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4830
Country	:	US
Telephone Number	:	402-321-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	10806 PRAIRIE HILLS DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4830
Country	:	US
Telephone Number	:	402-321-8995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MINDY SUE CROUCH
Credential	:	LCSW, LIMHP
Telephone Number	:	402-321-8995

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	06/17/2011

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