Healthcare Provider Details

I. General information

NPI: 1700713799
Provider Name (Legal Business Name): EMERALD PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 S 48TH ST STE 2
LINCOLN NE
68516-1287
US

IV. Provider business mailing address

4316 S 48TH ST STE 2
LINCOLN NE
68516-1287
US

V. Phone/Fax

Practice location:
  • Phone: 402-235-9224
  • Fax: 402-226-8894
Mailing address:
  • Phone: 402-235-9224
  • Fax: 402-226-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CONNOR SULLIVAN
Title or Position: OWNER, MENTAL HEALTH THERAPIST
Credential: MSW, PLMHP, PCMSW
Phone: 402-570-2078