Healthcare Provider Details

I. General information

NPI: 1821915190
Provider Name (Legal Business Name): LIGHT ROOTS BEHAVIORAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 FORT CROOK RD S STE 300
BELLEVUE NE
68005-2990
US

IV. Provider business mailing address

1408 FORT CROOK RD S STE 300
BELLEVUE NE
68005-2990
US

V. Phone/Fax

Practice location:
  • Phone: 402-904-0853
  • Fax:
Mailing address:
  • Phone: 402-904-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DOHA TOMA
Title or Position: MENTAL HEALTH PRACTITIONER
Credential: PLMHP,PCMSW,CAS,CDP
Phone: 402-904-0853