Provider Demographics
NPI:1326806902
Name:OLEE, ACHAN
Entity Type:Individual
Prefix:
First Name:ACHAN
Middle Name:
Last Name:OLEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11112 JOHN GALT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-9838
Mailing Address - Country:US
Mailing Address - Phone:402-347-4191
Mailing Address - Fax:
Practice Address - Street 1:11112 JOHN GALT BLVD STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-9838
Practice Address - Country:US
Practice Address - Phone:402-347-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-24-331853106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician