Provider Demographics
NPI:1285627653
Name:PERDAEMS-VIGEN, NANON RENEE (LPC LMHP LANC)
Entity type:Individual
Prefix:MS
First Name:NANON
Middle Name:RENEE
Last Name:PERDAEMS-VIGEN
Suffix:
Gender:F
Credentials:LPC LMHP LANC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 N 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-2218
Mailing Address - Country:US
Mailing Address - Phone:402-964-0447
Mailing Address - Fax:
Practice Address - Street 1:6720 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-3211
Practice Address - Country:US
Practice Address - Phone:402-457-7778
Practice Address - Fax:402-457-7791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE450 LANC101YA0400X
NE2308 LMHP101YM0800X
NE1283 LPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health