Healthcare Provider Details

I. General information

NPI: 1457506636
Provider Name (Legal Business Name): AMARA C VAKOC M.A., PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 N 27TH ST
LINCOLN NE
68503-1128
US

IV. Provider business mailing address

1533 N 27TH ST
LINCOLN NE
68503-1128
US

V. Phone/Fax

Practice location:
  • Phone: 402-437-8835
  • Fax: 402-434-0794
Mailing address:
  • Phone: 402-437-8835
  • Fax: 402-434-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8700
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: