Healthcare Provider Details

I. General information

NPI: 1609654896
Provider Name (Legal Business Name): MICHAEL BAMFORTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S 11TH ST
LINCOLN NE
68502-3559
US

IV. Provider business mailing address

11550 I ST STE 100
OMAHA NE
68137-1222
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-5161
  • Fax: 402-799-1055
Mailing address:
  • Phone: 402-498-4700
  • Fax: 402-493-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2416
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15041
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: