1881958916 NPI number — A DESIRED LIFE THERAPY AND COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881958916 NPI number — A DESIRED LIFE THERAPY AND COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A DESIRED LIFE THERAPY AND COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881958916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8031 W CENTER RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68124-3158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-990-7362
Provider Business Mailing Address Fax Number:
402-763-8915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8031 W CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-990-7362
Provider Business Practice Location Address Fax Number:
402-763-8915
Provider Enumeration Date:
07/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KAIPUST
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
LICSW
Authorized Official Telephone Number:
402-990-7362

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3573 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 661 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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