Basic Information
| Provider Information | |||||||||
| NPI: | 1780808337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTON | ||||||||
| FirstName: | E | ||||||||
| MiddleName: | VIGINIA | ||||||||
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| Credential: | LMHP, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 641130 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681647130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722907 | ||||||||
| FaxNumber: | 4025723544 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 HARLAN DR | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680056604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022916789 | ||||||||
| FaxNumber: | 4022918806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 712 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.