Healthcare Provider Details

I. General information

NPI: 1720942279
Provider Name (Legal Business Name): WAVES OF CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 CORN DR
PAPILLION NE
68046-4749
US

IV. Provider business mailing address

2006 CORN DR
PAPILLION NE
68046-4749
US

V. Phone/Fax

Practice location:
  • Phone: 402-708-9346
  • Fax:
Mailing address:
  • Phone: 402-708-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER HUNT
Title or Position: CEO
Credential: LIMHP, CMSW
Phone: 402-708-9346