Provider Demographics
NPI:1861518763
Name:SOUTHERN SUDAN COMM ASS
Entity type:Organization
Organization Name:SOUTHERN SUDAN COMM ASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING LMHP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-554-0759
Mailing Address - Street 1:3610 DODGE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:402-554-0759
Mailing Address - Fax:402-561-9724
Practice Address - Street 1:3610 DODGE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:402-554-0759
Practice Address - Fax:402-561-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025485800Medicaid