Provider Demographics
NPI: | 1750544359 |
---|---|
Name: | OBEREMBT, MONICA LYNN (BS) |
Entity type: | Individual |
Prefix: | MS |
First Name: | MONICA |
Middle Name: | LYNN |
Last Name: | OBEREMBT |
Suffix: | |
Gender: | F |
Credentials: | BS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 210 GATEWAY MALL |
Mailing Address - Street 2: | 342 GREENTREE COURT |
Mailing Address - City: | LINCOLN |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68505-2489 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-434-2730 |
Mailing Address - Fax: | 402-434-2970 |
Practice Address - Street 1: | 210 GATEWAY MALL |
Practice Address - Street 2: | 342 GREENTREE COURT |
Practice Address - City: | LINCOLN |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68505-2489 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-434-2730 |
Practice Address - Fax: | 402-434-2970 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-07-03 |
Last Update Date: | 2008-07-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 718 | 101YA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NE | 345680000 | Other | MAGELLAN, FSI |
NE | 47075636930 | Medicaid | |
NE | 456304000 | Other | MAGELLAN, FSI |
NE | 47075636998 | Medicaid |