MEDICARE: SOPHIA SCHACK PHLMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14317	NE

General Provider Information

NPI Number	:	1023808326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA SCHACK PHLMP

Provider Business Mailing Address
First Line	:	2727 S 144TH ST STE 250
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-5236
Country	:	US
Telephone Number	:	402-408-9625
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 REGENCY PARKWAY DR STE 207
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3779
Country	:	US
Telephone Number	:	402-408-9625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/09/2025

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