| Sage Counseling Omaha Llc | |
|
13808 U St Omaha NE 68137-2904 | |
| (402) 885-6980 | |
| Not Available |
| Full Name | Sage Counseling Omaha Llc |
|---|---|
| Speciality | Counselor |
| Location | 13808 U St, Omaha, Nebraska |
| Authorized Official Name and Position | Loren Dexter (OWNER) |
| Authorized Official Contact | 4028856980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sage Counseling Omaha Llc 13808 U St Omaha NE 68137-2904 Ph: (402) 885-6980 | Sage Counseling Omaha Llc 13808 U St Omaha NE 68137-2904 Ph: (402) 885-6980 |
| NPI Number | 1568004653 |
|---|---|
| Provider Enumeration Date | 10/10/2019 |
| Last Update Date | 01/03/2020 |
| Certification Date | 01/03/2020 |
| Medicare PECOS PAC ID | 7214334523 |
|---|---|
| Medicare Enrollment ID | O20210928003374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568004653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Victoria L Vantol |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326552050 PECOS PAC ID: 5193159598 Enrollment ID: I20191217002870 |
| Provider Name | Brittany Lee Matney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013492966 PECOS PAC ID: 4880092808 Enrollment ID: I20211006000372 |
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