Healthcare Provider Details

I. General information

NPI: 1932064789
Provider Name (Legal Business Name): GREGG LEE MADSEN PLMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4383 NICHOLAS ST
OMAHA NE
68131-1008
US

IV. Provider business mailing address

6415 S 175TH ST
OMAHA NE
68135-3065
US

V. Phone/Fax

Practice location:
  • Phone: 402-916-9421
  • Fax:
Mailing address:
  • Phone: 402-916-9421
  • Fax: 402-999-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14713
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: