Healthcare Provider Details

I. General information

NPI: 1609231034
Provider Name (Legal Business Name): REBECCA RISTOW LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 VAN DORN ST
LINCOLN NE
68506-6801
US

IV. Provider business mailing address

6911 VAN DORN ST
LINCOLN NE
68506-6801
US

V. Phone/Fax

Practice location:
  • Phone: 402-613-8135
  • Fax: 531-500-5815
Mailing address:
  • Phone: 402-613-8135
  • Fax: 531-500-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4978
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2177
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2177
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: