Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 809 | NE |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 960 | NE |
N | 101YM0800X | Mental Health Counselor | 7780 | NE |
N | 101YM0800X | Mental Health Counselor | 809 | NE |
NPI | 1003842568 |
---|---|
Provider Name | Diana M Meadors |
First Address | Elkhorn, NE 68022-2141 |
Second Address | Elkhorn, NE 68022-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10024992300 | (05) | NE |