Healthcare Provider Details

I. General information

NPI: 1205760170
Provider Name (Legal Business Name): AMANDA BOESCH
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

11605 ARBOR ST STE 106
OMAHA NE
68144-2982
US

IV. Provider business mailing address

2714 N 190TH ST
ELKHORN NE
68022-2935
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-0960
  • Fax:
Mailing address:
  • Phone: 402-889-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14950
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: