Healthcare Provider Details

I. General information

NPI: 1639016454
Provider Name (Legal Business Name): OLIVIA DAVIS MA, PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 UNION DR STE 100
LINCOLN NE
68516-6629
US

IV. Provider business mailing address

3701 UNION DR
LINCOLN NE
68516-6629
US

V. Phone/Fax

Practice location:
  • Phone: 402-205-5677
  • Fax: 402-417-0411
Mailing address:
  • Phone: 402-205-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: