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NPI Code Detail

MEDICARE: MYRA JEANNE KWAST-LIPKER LMHP

MEDICARE: MYRA JEANNE KWAST-LIPKER 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
1101YM0800XMental Health Counselor8145NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18145OTHERNESTATE LISENSE

General Provider Information

NPI Number : 1891990644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRA JEANNE KWAST-LIPKER LMHP
Provider Business Mailing Address
First Line : 710 E 10TH ST
Second Line :
City : SUPERIOR
State : NE
Zip : 68978-2305
Country : US
Telephone Number : 402-879-3647
Fax Number : 402-746-5684
Provider Business Practice Location Address
First Line : 721 W 6TH AVE
Second Line :
City : RED CLOUD
State : NE
Zip : 68970-2278
Country : US
Telephone Number : 402-746-5614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 07/08/2007

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