Healthcare Provider Details

I. General information

NPI: 1154237352
Provider Name (Legal Business Name): AMBER MAGALLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 THOMPSON CREEK BLVD STE 3
LINCOLN NE
68516-6579
US

IV. Provider business mailing address

5700 THOMPSON CREEK BLVD STE 3
LINCOLN NE
68516-6579
US

V. Phone/Fax

Practice location:
  • Phone: 308-227-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15083
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: