Healthcare Provider Details

I. General information

NPI: 1154254084
Provider Name (Legal Business Name): ELAINE CONNELLY PMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 J ST
OMAHA NE
68107-1643
US

IV. Provider business mailing address

2968 MARTHA ST
OMAHA NE
68105-3227
US

V. Phone/Fax

Practice location:
  • Phone: 402-733-3487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14958
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: