Provider Demographics
NPI:1902990864
Name:EIGENBERG, AMY R (LIMHP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:EIGENBERG
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:TUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP
Mailing Address - Street 1:2908 W 39TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1245
Mailing Address - Country:US
Mailing Address - Phone:308-237-0391
Mailing Address - Fax:308-708-7452
Practice Address - Street 1:2908 W 39TH ST STE B
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-237-0391
Practice Address - Fax:308-708-7452
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE823101YA0400X
NE398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026704700Medicaid
NE$$$$$$$$$05Medicaid