Provider Demographics
NPI:1205024155
Name:OBRIST, BRIAN PAUL (LIMHP, LCSW, PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:OBRIST
Suffix:
Gender:M
Credentials:LIMHP, LCSW, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 41ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1028
Mailing Address - Country:US
Mailing Address - Phone:402-562-7500
Mailing Address - Fax:402-564-0611
Practice Address - Street 1:4321 41ST AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68602-1028
Practice Address - Country:US
Practice Address - Phone:402-562-7500
Practice Address - Fax:402-564-0611
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3251101YM0800X
NE1243104100000X
NE1664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant