Healthcare Provider Details

I. General information

NPI: 1063324614
Provider Name (Legal Business Name): MR. ARDJOUMAN MOHAMED BAMBA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 N 110TH PLZ APT 1509
OMAHA NE
68154-4581
US

IV. Provider business mailing address

1312 N 110TH PLZ APT 1509
OMAHA NE
68154-4581
US

V. Phone/Fax

Practice location:
  • Phone: 402-383-5784
  • Fax: 402-383-5784
Mailing address:
  • Phone: 402-383-5784
  • Fax: 402-383-5784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: