Healthcare Provider Details

I. General information

NPI: 1003341512
Provider Name (Legal Business Name): STRATEGIC PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2017
Last Update Date: 04/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5561 S 48TH ST STE 201G
LINCOLN NE
68516-4109
US

IV. Provider business mailing address

PO BOX 22571
LINCOLN NE
68542-2571
US

V. Phone/Fax

Practice location:
  • Phone: 402-858-7774
  • Fax: 402-480-7192
Mailing address:
  • Phone: 402-858-7774
  • Fax: 402-480-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number853
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number853
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number853
License Number StateNE

VIII. Authorized Official

Name: DR. AMANDA HOLMGREEN
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSY.D
Phone: 402-858-7774