Provider Demographics
NPI:1932539426
Name:WEATHERALL, LILLIE LYN (MS, NCC, LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:LYN
Last Name:WEATHERALL
Suffix:
Gender:F
Credentials:MS, NCC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-598-3343
Mailing Address - Fax:
Practice Address - Street 1:3308 SAMSON WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3234
Practice Address - Country:US
Practice Address - Phone:402-598-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health