Healthcare Provider Details

I. General information

NPI: 1124846167
Provider Name (Legal Business Name): DIAMOND PEVERILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8998 L ST STE 110
OMAHA NE
68127-1400
US

IV. Provider business mailing address

8998 L ST STE 110
OMAHA NE
68127-1400
US

V. Phone/Fax

Practice location:
  • Phone: 402-651-5404
  • Fax:
Mailing address:
  • Phone: 402-651-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2022
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: