Provider Demographics
NPI:1760921597
Name:ALICEA, MEGHAN (CSS)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:CSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 FNB PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-7200
Mailing Address - Country:US
Mailing Address - Phone:402-807-7447
Mailing Address - Fax:617-340-3371
Practice Address - Street 1:124 S 24TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1226
Practice Address - Country:US
Practice Address - Phone:402-341-7007
Practice Address - Fax:402-661-7117
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEBACB1045397106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician