Provider Demographics
NPI:1760836415
Name:GALLAGHER, AMANDA (PLMHP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GALLAGHER
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 1:3801 UNION DR STE 206
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6652
Mailing Address - Country:US
Mailing Address - Phone:402-489-2218
Mailing Address - Fax:402-489-3666
Practice Address - Street 1:2444 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1125
Practice Address - Country:US
Practice Address - Phone:402-475-7666
Practice Address - Fax:402-476-9623
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health