| Dymphna Holdings, Inc. | |
|
12110 Port Grace Blvd La Vista NE 68128-3190 | |
| (402) 630-6421 | |
| Not Available |
| Full Name | Dymphna Holdings, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 12110 Port Grace Blvd, La Vista, Nebraska |
| Authorized Official Name and Position | Marian R Weaver (PRESIDENT) |
| Authorized Official Contact | 4026306421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dymphna Holdings, Inc. 1506 S 152nd Avenue Cir Omaha NE 68144-5115 Ph: (402) 630-6421 | Dymphna Holdings, Inc. 12110 Port Grace Blvd La Vista NE 68128-3190 Ph: (402) 630-6421 |
| NPI Number | 1306681861 |
|---|---|
| Provider Enumeration Date | 06/27/2024 |
| Last Update Date | 06/27/2024 |
| Certification Date | 06/26/2024 |
| Medicare PECOS PAC ID | 1254863442 |
|---|---|
| Medicare Enrollment ID | O20241012000129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306681861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Michelle A. Melroy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700035409 PECOS PAC ID: 9234675430 Enrollment ID: I20240724002088 |
| Provider Name | Joseph Brent Suchanic |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871052134 PECOS PAC ID: 4981136173 Enrollment ID: I20241012000144 |
| Provider Name | Cassandra Jo Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730811605 PECOS PAC ID: 4486186608 Enrollment ID: I20241014000988 |
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