Healthcare Provider Details
I. General information
NPI: 1831643964
Provider Name (Legal Business Name): FOCUS C3, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/05/2016
Last Update Date: 03/01/2022
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
10748 VIRGINIA PLZ SUITE 107
LA VISTA NE
68128-3204
US
IV. Provider business mailing address
10748 VIRGINIA PLZ SUITE107
LAVISTA NE
68128-3204
US
V. Phone/Fax
- Phone: 402-933-4411
- Fax: 888-507-5931
- Phone: 402-933-4411
- Fax: 888-507-5931
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
AMANDA
J
HEBNER
Title or Position: PRESIDENT
Credential: PLMHP
Phone: 402-933-4411