Provider Demographics
NPI:1336285196
Name:WIEST, AMBER K (MA)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:K
Last Name:WIEST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S 15TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-3186
Mailing Address - Country:US
Mailing Address - Phone:402-315-0415
Mailing Address - Fax:
Practice Address - Street 1:1215 LEAVENWORTH ST STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-3214
Practice Address - Country:US
Practice Address - Phone:402-315-0415
Practice Address - Fax:402-486-1600
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1039101YM0800X
NE8299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE391988264-26Medicaid