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General NPI Number Information
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NPI Number | 1508440199
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Entity Type | Individual
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Provider Name | AMBER STAR PACE PLMHP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 5550 S 59TH ST STE 11
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City | LINCOLN
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State | NE
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Zip | 68516-2398
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Country | US
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Telephone | 531-289-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 6564 LAS VERDES LN
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City | LINCOLN
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State | NE
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Zip | 68523-9316
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Country | US
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Telephone | 402-480-4819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12539
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License Number State | NE
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