Healthcare Provider Details

I. General information

NPI: 1528976529
Provider Name (Legal Business Name): ASHLEY MANCHESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 S 107TH AVE
OMAHA NE
68127-1904
US

IV. Provider business mailing address

17752 PIERCE CT APT W209
OMAHA NE
68130-1342
US

V. Phone/Fax

Practice location:
  • Phone: 402-455-0808
  • Fax: 402-881-8668
Mailing address:
  • Phone: 405-455-0808
  • Fax: 402-881-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15064
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: