Provider Demographics
NPI:1508210642
Name:WOOTEN, MICHELLE ANN (LIMHP, CPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:LIMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12019 S 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4609
Mailing Address - Country:US
Mailing Address - Phone:402-309-4487
Mailing Address - Fax:
Practice Address - Street 1:1600 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1568
Practice Address - Country:US
Practice Address - Phone:402-309-4487
Practice Address - Fax:402-937-8324
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10823101YM0800X
NE2394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health