Provider Demographics
NPI:1457829913
Name:AMY RIESSLAND LLC
Entity Type:Organization
Organization Name:AMY RIESSLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIESSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP, LMSW, LISW
Authorized Official - Phone:402-882-5840
Mailing Address - Street 1:7872 TILFORD CIR
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2718
Mailing Address - Country:US
Mailing Address - Phone:402-882-5840
Mailing Address - Fax:
Practice Address - Street 1:2929 S 120TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4310
Practice Address - Country:US
Practice Address - Phone:402-882-5840
Practice Address - Fax:402-882-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health