1699767749 NPI number — ALYSON LYNN MEADOWS MS LPC CPC NCC

Table of content: ALYSON LYNN MEADOWS MS LPC CPC NCC (NPI 1699767749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699767749 NPI number — ALYSON LYNN MEADOWS MS LPC CPC NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADOWS
Provider First Name:
ALYSON
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS LPC CPC NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
ALYSON
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699767749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 S 50TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68106-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-813-2487
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7561 MAIN ST
Provider Second Line Business Practice Location Address:
STE 417
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68127-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-813-2487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  1434 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: 2681 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85444 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 240322 . This is a "MIDLANDS CHOICE CACTUS ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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