Provider Demographics
NPI:1164967220
Name:DIRKS, AMBER (LIMHP LADC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DIRKS
Suffix:
Gender:F
Credentials:LIMHP LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 P ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3528
Mailing Address - Country:US
Mailing Address - Phone:402-475-5161
Mailing Address - Fax:402-435-0430
Practice Address - Street 1:2202 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3559
Practice Address - Country:US
Practice Address - Phone:402-475-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1214101YA0400X
NE1842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP-1269OtherPLADC
NE10459OtherPLMHP