MEDICARE: DOUGLAS O DRAEGER 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	2013	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84124	OTHER	NE	BLUE CROSS & BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	229097	OTHER	NE	MIDLANDS CHOICE INS

General Provider Information

NPI Number	:	1972688893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS O DRAEGER LMHP

Provider Business Mailing Address
First Line	:	2282 E 32ND AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-7233
Country	:	US
Telephone Number	:	402-563-9224
Fax Number	:	402-563-0544

Provider Business Practice Location Address
First Line	:	2282 E 32ND AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-7233
Country	:	US
Telephone Number	:	402-563-9224
Fax Number	:	402-563-0544

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	11/11/2008

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