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General NPI Number Information
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NPI Number | 1679845945
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Entity Type | Organization
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Legal Business Name | LISA RIEKENBERG
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 3534 S 48TH ST STE 3A
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City | LINCOLN
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State | NE
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Zip | 68506-6425
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Country | US
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Telephone | 420-477-7170
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Fax | 402-477-7173
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Provider Business Mailing Address
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Address Line | 3534 S 48TH ST STE 3A
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City | LINCOLN
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State | NE
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Zip | 68506-6425
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Country | US
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Telephone | 420-477-7170
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Fax | 402-477-7173
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Authorized Official
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Title or Position | OWNER
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Name | LISA M RIEKENBERG
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Credential | LIMHP LPC LADC
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Telephone | 420-477-7170
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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 | 292
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License Number State | NE
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