Healthcare Provider Details

I. General information

NPI: 1760836415
Provider Name (Legal Business Name): AMANDA GALLAGHER PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 O ST
LINCOLN NE
68510-1125
US

IV. Provider business mailing address

3801 UNION DR STE 206
LINCOLN NE
68516-6652
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-7666
  • Fax: 402-476-9623
Mailing address:
  • Phone: 402-489-2218
  • Fax: 402-489-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10775
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: