Healthcare Provider Details

I. General information

NPI: 1619750916
Provider Name (Legal Business Name): THE ATTACHMENT AND TRAUMA CENTER OF NEBRASKA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 N 109TH PLZ
OMAHA NE
68154-1722
US

IV. Provider business mailing address

638 N 109TH PLZ
OMAHA NE
68154-1722
US

V. Phone/Fax

Practice location:
  • Phone: 402-403-0190
  • Fax: 402-932-4121
Mailing address:
  • Phone: 402-403-0190
  • Fax: 402-932-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GAIL JEAN LITTLE-OSBERG
Title or Position: PRACTICE MANAGER
Credential:
Phone: 402-403-0190