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General NPI Number Information
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NPI Number | 1518637743
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Entity Type | Organization
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Legal Business Name | ROSE MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 09/18/2021
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Last Update Date | 09/18/2021
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Provider Practice Location Address
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Address Line | 610 J ST STE 210
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City | LINCOLN
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State | NE
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Zip | 68508-2967
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Country | US
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Telephone | 402-413-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 610 J ST STE 210
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City | LINCOLN
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State | NE
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Zip | 68508-2967
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Country | US
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Telephone | 402-413-1411
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | JAMIE ROSE LIEBENTRITT
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Credential | MSW, LICSW, LIMHP
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Telephone | 402-413-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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