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1111 S 119th St Omaha NE 68144-1601 | |
| (402) 991-7441 | |
| (402) 991-7445 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1111 S 119th St, Omaha, Nebraska |
| Authorized Official Name and Position | Janet Michelle Johnston (OWNER AND CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4029917441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1111 S 119th St Omaha NE 68144-1601 Ph: (402) 991-7441 | 1111 S 119th St Omaha NE 68144-1601 Ph: (402) 991-7441 |
| NPI Number | 1134250632 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8224353685 |
|---|---|
| Medicare Enrollment ID | O20150206001768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134250632 | NPI | - | NPPES |
| 240598 | Other | NE | MIDLANDS CHOICE |
| 100253396-00 | Medicaid | NE | |
| 82003 | Other | NE | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2846 (Nebraska) | Primary |
| 1041C0700X | Social Worker - Clinical | 1146 (Nebraska) | Secondary |
| Provider Name | Amy P Jonas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497925192 PECOS PAC ID: 4587798947 Enrollment ID: I20110729000475 |
| Provider Name | Janet M Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720110562 PECOS PAC ID: 4486979846 Enrollment ID: I20150206001906 |
| Provider Name | Elizabeth Jo Domina |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760534473 PECOS PAC ID: 9638517865 Enrollment ID: I20240405002579 |
| Provider Name | Brenda L Ticknor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093982118 PECOS PAC ID: 8325480965 Enrollment ID: I20240528001971 |
| Provider Name | Kristine Ruth Severe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669799300 PECOS PAC ID: 5496990954 Enrollment ID: I20240528003690 |
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