MEDICARE: KATRINA ANNE LETHEBY M.S.

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	7679	NE

General Provider Information

NPI Number	:	1730279282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA ANNE LETHEBY M.S.

Provider Business Mailing Address
First Line	:	329 MALLARD LANE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801
Country	:	US
Telephone Number	:	308-383-9254
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 MALLARD LN
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-8544
Country	:	US
Telephone Number	:	308-383-9254
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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