| Mary Kay Wood, Llc | |
|
3611 Lowell Ave Lincoln NE 68506-4848 | |
| (402) 483-1344 | |
| (402) 477-8284 |
| Full Name | Mary Kay Wood, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3611 Lowell Ave, Lincoln, Nebraska |
| Authorized Official Name and Position | Mary Kay Wood (OWNER) |
| Authorized Official Contact | 4024831344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Kay Wood, Llc 3611 Lowell Ave Lincoln NE 68506-4848 Ph: (402) 483-1344 | Mary Kay Wood, Llc 3611 Lowell Ave Lincoln NE 68506-4848 Ph: (402) 483-1344 |
| NPI Number | 1689295560 |
|---|---|
| Provider Enumeration Date | 05/01/2020 |
| Last Update Date | 08/28/2020 |
| Certification Date | 08/28/2020 |
| Medicare PECOS PAC ID | 2062843980 |
|---|---|
| Medicare Enrollment ID | O20200510000197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689295560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary Kay Wood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033297064 PECOS PAC ID: 9537285887 Enrollment ID: I20100924000190 |
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