Provider Demographics
NPI:1053776831
Name:GEORGE, NIKA (PHD)
Entity type:Individual
Prefix:DR
First Name:NIKA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S 144TH ST STE 216
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5337
Mailing Address - Country:US
Mailing Address - Phone:402-350-6463
Mailing Address - Fax:
Practice Address - Street 1:139 S 144TH ST STE 216
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5337
Practice Address - Country:US
Practice Address - Phone:402-350-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE976103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12632OtherPSYPACT CERTIFICATION
NE976OtherLICENSE