Healthcare Provider Details

I. General information

NPI: 1053240796
Provider Name (Legal Business Name): ABIGAIL MARGARET ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 HILLCREST DR
BLAIR NE
68008-1800
US

IV. Provider business mailing address

6902 PINE ST
OMAHA NE
68106-2855
US

V. Phone/Fax

Practice location:
  • Phone: 402-916-0306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: