Healthcare Provider Details

I. General information

NPI: 1790530459
Provider Name (Legal Business Name): AMANDA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S 70TH ST STE 200
LINCOLN NE
68506-1566
US

IV. Provider business mailing address

1520 S 70TH ST STE 200
LINCOLN NE
68506-1566
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-1936
  • Fax: 402-483-7314
Mailing address:
  • Phone: 402-483-1936
  • Fax: 402-483-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6313
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13554
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: