Provider Demographics
NPI:1194169722
Name:AMEDEDJI, KOMI TONY (MS, LIMHP)
Entity type:Individual
Prefix:MR
First Name:KOMI
Middle Name:TONY
Last Name:AMEDEDJI
Suffix:
Gender:M
Credentials:MS, LIMHP
Other - Prefix:
Other - First Name:KOMI
Other - Middle Name:HONU
Other - Last Name:AMEDEDJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 538
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:268 N 115TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2502
Practice Address - Country:US
Practice Address - Phone:402-957-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1823101YM0800X
NE9931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health