Healthcare Provider Details

I. General information

NPI: 1487312559
Provider Name (Legal Business Name): LIFESPAN COUNSELING OMAHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W DODGE RD STE 106
OMAHA NE
68114-3430
US

IV. Provider business mailing address

15705 W DODGE ROAD 102
OMAHA NE
68118-2536
US

V. Phone/Fax

Practice location:
  • Phone: 402-575-5577
  • Fax:
Mailing address:
  • Phone: 402-575-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MYISHA PARSHA
Title or Position: CO-OWNER
Credential: LIMHP
Phone: 531-444-1963