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General NPI Number Information
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NPI Number | 1609370261
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Entity Type | Organization
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Legal Business Name | AME PSYCHOTHERAPY
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 15815 WILLOW ST
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City | OMAHA
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State | NE
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Zip | 68136-3176
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Country | US
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Telephone | 229-506-2708
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Fax |
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Provider Business Mailing Address
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Address Line | 15815 WILLOW ST
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City | OMAHA
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State | NE
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Zip | 68136-3176
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Country | US
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Telephone | 229-506-2708
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Fax |
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Authorized Official
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Title or Position | PLMHP
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Name | ANGELA MARY ERICKSON
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Credential | M.A.
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Telephone | 229-506-2708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11080
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License Number State | NE
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