Provider Demographics
NPI:1326243288
Name:ANDERSEN, BRIAN ERIC (MA, LMHP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ERIC
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MA, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2517
Mailing Address - Country:US
Mailing Address - Phone:402-216-7457
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 514
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2981
Practice Address - Country:US
Practice Address - Phone:402-614-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health