Provider Demographics
NPI:1891455879
Name:WAHBA, AMEEN
Entity Type:Individual
Prefix:
First Name:AMEEN
Middle Name:
Last Name:WAHBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CARTER LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51510-1173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2126 N 117TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3670
Practice Address - Country:US
Practice Address - Phone:402-934-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health