Basic Information
| Provider Information | |||||||||
| NPI: | 1891183455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | LYNDSEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | LMHP, LIMHP, LADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLEWELL | ||||||||
| OtherFirstName: | LYNDSEY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13460 WALSH DR | ||||||||
| Address2: | |||||||||
| City: | BOYS TOWN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680107529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5313553358 | ||||||||
| FaxNumber: | 5313553375 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681113872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024559757 | ||||||||
| FaxNumber: | 4025915075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2015 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | P-1226 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | 1994 | NE | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.