Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 407 | NE |
N | 101YM0800X | Mental Health Counselor | 1681 | NE |
N | 101YP2500X | Professional Counselor | 1017 | NE |
NPI | 1003987736 |
---|---|
Provider Name | Michele Yvonne Wilson |
First Address | Lincoln, NE 68522-1153 |
Second Address | Lincoln, NE 68522-1153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025441800 | (05) | NE |
85542 | BLUE CROSS BLUE SHIELD (01) | NE |