Provider Demographics
NPI:1205356078
Name:AMBER WIEST LLC
Entity Type:Organization
Organization Name:AMBER WIEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THEAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WIEST
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, PLADC
Authorized Official - Phone:308-293-9488
Mailing Address - Street 1:4060 VINTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3863
Mailing Address - Country:US
Mailing Address - Phone:308-293-9488
Mailing Address - Fax:866-295-7627
Practice Address - Street 1:4060 VINTON ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-3863
Practice Address - Country:US
Practice Address - Phone:308-293-9488
Practice Address - Fax:866-295-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026663300Medicaid