Healthcare Provider Details

I. General information

NPI: 1558661900
Provider Name (Legal Business Name): MRS. COREY CHRISTINE LIENEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 PINE ST
OMAHA NE
68106-2855
US

IV. Provider business mailing address

985450 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5450
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6408
  • Fax: 402-559-5737
Mailing address:
  • Phone: 402-559-6408
  • Fax: 402-559-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9265
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number683
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2655
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9265
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1094
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: