Healthcare Provider Details

I. General information

NPI: 1710232608
Provider Name (Legal Business Name): AMANDA JO HEBNER PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 02/22/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10748 VIRGINIA PLZ SUITE 107
LAVISTA NE
68128-3204
US

IV. Provider business mailing address

10748 VIRGINIA PLZ, SUITE 107
LAVISTA NE
68128-3204
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-4411
  • Fax:
Mailing address:
  • Phone: 402-933-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1758
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: