| Fresh Start Therapy Llc | |
|
1055 N 115th St Ste 105 Omaha NE 68154-4419 | |
| (402) 937-8619 | |
| Not Available |
| Full Name | Fresh Start Therapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 1055 N 115th St Ste 105, Omaha, Nebraska |
| Authorized Official Name and Position | Andrew Eric Koepp (PRESIDENT/FOUNDER) |
| Authorized Official Contact | 4029378619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Start Therapy Llc 8011 Grover St Omaha NE 68124-3331 Ph: (402) 740-4447 | Fresh Start Therapy Llc 1055 N 115th St Ste 105 Omaha NE 68154-4419 Ph: (402) 937-8619 |
| NPI Number | 1396574471 |
|---|---|
| Provider Enumeration Date | 07/29/2024 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Medicare PECOS PAC ID | 7810434552 |
|---|---|
| Medicare Enrollment ID | O20240731000961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396574471 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Andrew Eric Koepp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023781168 PECOS PAC ID: 0244777985 Enrollment ID: I20240731001176 |
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