Healthcare Provider Details

I. General information

NPI: 1922588516
Provider Name (Legal Business Name): AARON THOMAS YOUNGBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 03/17/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARBOR DRIVE
SOUTH SIOUX CITY NE
68776-2652
US

IV. Provider business mailing address

PO BOX 355
SOUTH SIOUX CITY NE
68776-0355
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-3337
  • Fax: 402-494-3356
Mailing address:
  • Phone: 402-494-3337
  • Fax: 402-494-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11585
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: