MEDICARE: MRS. CHERYLN J WAHLGREN LMHP

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	2044	NE

General Provider Information

NPI Number	:	1871578708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYLN J WAHLGREN LMHP

Provider Business Mailing Address
First Line	:	221 W 2ND ST
Second Line	:	STE 105
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-3905
Country	:	US
Telephone Number	:	308-534-3351
Fax Number	:	308-696-3801

Provider Business Practice Location Address
First Line	:	221 W 2ND ST
Second Line	:	STE 105
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-3905
Country	:	US
Telephone Number	:	308-534-3351
Fax Number	:	308-696-3801

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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