Provider Demographics
NPI:1568262434
Name:EKSTEIN, MICKAH JEAN
Entity type:Individual
Prefix:
First Name:MICKAH
Middle Name:JEAN
Last Name:EKSTEIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JEAN
Other - Last Name:EKSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 SAINT PAUL AVE # SMB2038
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-2760
Mailing Address - Country:US
Mailing Address - Phone:402-469-5243
Mailing Address - Fax:
Practice Address - Street 1:14301 FNB PKWY STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-7200
Practice Address - Country:US
Practice Address - Phone:402-807-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-25-414587106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician