Healthcare Provider Details

I. General information

NPI: 1285011239
Provider Name (Legal Business Name): AMBER JURGENSMEIER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11713 M CIRCLE
OMAHA NE
68137
US

IV. Provider business mailing address

16009 CURTIS AVE
OMAHA NE
68116
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-4411
  • Fax: 888-507-5931
Mailing address:
  • Phone: 402-340-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1317
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number946
License Number StateNE

VIII. Authorized Official

Name: AMBER DAWN JURGENSMEIER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW, LADC
Phone: 402-340-4909