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11414 W Center Rd Ste 247 Omaha NE 68144-4425 | |
| (402) 598-9601 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 11414 W Center Rd Ste 247, Omaha, Nebraska |
| Authorized Official Name and Position | Brandy Baumgart (CO-OWNER) |
| Authorized Official Contact | 4025989601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11414 W Center Rd Ste 247 Omaha NE 68144-4425 Ph: (402) 598-9601 | 11414 W Center Rd Ste 247 Omaha NE 68144-4425 Ph: (402) 598-9601 |
| NPI Number | 1275201626 |
|---|---|
| Provider Enumeration Date | 09/01/2021 |
| Last Update Date | 01/06/2022 |
| Certification Date | 01/06/2022 |
| Medicare PECOS PAC ID | 8224474150 |
|---|---|
| Medicare Enrollment ID | O20240313002656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275201626 | NPI | - | NPPES |
| 48113684219 | Medicaid | NE | |
| 50529460104 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Brandelyn Nicole Baumgart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174870083 PECOS PAC ID: 7012353949 Enrollment ID: I20240313002796 |
| Provider Name | Kimberly Ellenberger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366092157 PECOS PAC ID: 9638600703 Enrollment ID: I20240930002970 |
| Provider Name | Gina Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164092664 PECOS PAC ID: 6002347184 Enrollment ID: I20240930003358 |
| Provider Name | Jill Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891094371 PECOS PAC ID: 4284165374 Enrollment ID: I20240930003383 |
| Provider Name | Nicholas Bundy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508303827 PECOS PAC ID: 8224560750 Enrollment ID: I20241022001858 |
| Provider Name | Jessica M Nemec |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316334857 PECOS PAC ID: 5395277842 Enrollment ID: I20241022002438 |
| Provider Name | Judy Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548846827 PECOS PAC ID: 8628501129 Enrollment ID: I20241022004871 |
| Provider Name | Caitlin Richter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376193680 PECOS PAC ID: 3476087982 Enrollment ID: I20241106002216 |
| Provider Name | Elizabeth Brittenham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306154950 PECOS PAC ID: 6507188232 Enrollment ID: I20241205002159 |
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