MEDICARE: SERENE OWL COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1043194178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE OWL COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1006 CONESTOGA RD
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-3519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 N 115TH ST STE 5
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2558
Country	:	US
Telephone Number	:	402-255-6137
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAIGE TUTTLE
Credential	:	LICSW, LISW
Telephone Number	:	402-617-7492

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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