Provider Demographics
NPI:1790156040
Name:ORIGINS HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ORIGINS HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:402-489-9990
Mailing Address - Street 1:2123 WINTHROP RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4156
Mailing Address - Country:US
Mailing Address - Phone:402-489-9990
Mailing Address - Fax:402-261-9202
Practice Address - Street 1:2123 WINTHROP RD
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4156
Practice Address - Country:US
Practice Address - Phone:402-489-9990
Practice Address - Fax:402-261-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELIMHP 1088; LADC 697101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253331-00Medicaid