Provider Demographics
NPI:1801157912
Name:RILEY, LATAUNA A (LPC, LIMHP)
Entity type:Individual
Prefix:
First Name:LATAUNA
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC, LIMHP
Other - Prefix:
Other - First Name:LATAUNYA
Other - Middle Name:A
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11907 ARBOR ST STE C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3002
Mailing Address - Country:US
Mailing Address - Phone:531-250-4099
Mailing Address - Fax:531-250-4099
Practice Address - Street 1:11907 ARBOR ST STE C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3002
Practice Address - Country:US
Practice Address - Phone:531-250-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YP2500X
NE966101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025745300Medicaid
NE10026139700Medicaid
NE47037660631Medicaid