MEDICARE: E VIGINIA WESTON LMHP, RN

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	712	NE

General Provider Information

NPI Number	:	1780808337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	E VIGINIA WESTON LMHP, RN

Provider Business Mailing Address
First Line	:	PO BOX 641130
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-7130
Country	:	US
Telephone Number	:	402-572-2907
Fax Number	:	402-572-3544

Provider Business Practice Location Address
First Line	:	1309 HARLAN DR
Second Line	:	SUITE 206
City	:	BELLEVUE
State	:	NE
Zip	:	68005-6604
Country	:	US
Telephone Number	:	402-291-6789
Fax Number	:	402-291-8806

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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