Provider Demographics
NPI:1508440199
Name:PACE, AMBER STAR (PLMHP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:STAR
Last Name:PACE
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 LAS VERDES LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-9316
Mailing Address - Country:US
Mailing Address - Phone:402-480-4819
Mailing Address - Fax:
Practice Address - Street 1:5550 S 59TH ST STE 11
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2398
Practice Address - Country:US
Practice Address - Phone:531-289-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health