Provider Demographics
NPI:1437665759
Name:IGBOANUSI, GERALD CHIBUZOR (COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:CHIBUZOR
Last Name:IGBOANUSI
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14204 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1200
Mailing Address - Country:US
Mailing Address - Phone:402-953-4240
Mailing Address - Fax:
Practice Address - Street 1:14204 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1200
Practice Address - Country:US
Practice Address - Phone:402-953-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2515101YP2500X
NE5312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty