Healthcare Provider Details

I. General information

NPI: 1609370261
Provider Name (Legal Business Name): AME PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15815 WILLOW ST
OMAHA NE
68136-3176
US

IV. Provider business mailing address

15815 WILLOW ST
OMAHA NE
68136-3176
US

V. Phone/Fax

Practice location:
  • Phone: 229-506-2708
  • Fax:
Mailing address:
  • Phone: 229-506-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11080
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MARY ERICKSON
Title or Position: PLMHP
Credential: M.A.
Phone: 229-506-2708