Provider Demographics
NPI:1184195760
Name:EMILEE L. O'BRIEN LICSW LLC
Entity Type:Organization
Organization Name:EMILEE L. O'BRIEN LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILEE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:402-768-8491
Mailing Address - Street 1:1705 G. STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361
Mailing Address - Country:US
Mailing Address - Phone:402-768-8491
Mailing Address - Fax:
Practice Address - Street 1:1320 G ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-2104
Practice Address - Country:US
Practice Address - Phone:402-768-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1932625647OtherBCBS
NE1932625647Medicaid