Provider Demographics
NPI:1083400584
Name:IDENTITY MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:IDENTITY MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LISW
Authorized Official - Phone:402-685-8687
Mailing Address - Street 1:4738 S 167TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1334
Mailing Address - Country:US
Mailing Address - Phone:402-685-8687
Mailing Address - Fax:402-899-4034
Practice Address - Street 1:11919 P ST STE C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2226
Practice Address - Country:US
Practice Address - Phone:402-685-8687
Practice Address - Fax:402-899-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty