Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 9498 | NE |
Y | 102L00000X | Psychologist | 863 | NE |
Y | 103T00000X | Psychologist | 863 | NE |
NPI | 1003178492 |
---|---|
Provider Name | Lindsay Miranda Booker |
First Address | Omaha, NE 68198-5450 |
Second Address | Omaha, NE 68198-5450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025287200 | (05) | NE |