Healthcare Provider Details

I. General information

NPI: 1770862872
Provider Name (Legal Business Name): AMBER DAWN JURGENSMEIER LICSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11713 M CIR
OMAHA NE
68137-2218
US

IV. Provider business mailing address

16009 CURTIS AVE.
OMAHA NE
68116
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1561
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number946
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1317
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: