Healthcare Provider Details

I. General information

NPI: 1972673119
Provider Name (Legal Business Name): NOELLE C PHILLIPS LICSW, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20324 VETERANS DR STE 104
ELKHORN NE
68022-3552
US

IV. Provider business mailing address

20324 VETERANS DR STE 104
ELKHORN NE
68022-3552
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-5700
  • Fax: 402-933-9998
Mailing address:
  • Phone: 402-933-5700
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1856
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2115
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: