Provider Demographics
NPI: | 1437695913 |
---|---|
Name: | OMAHA FAMILY COUNSELING PLACE LLC |
Entity Type: | Organization |
Organization Name: | OMAHA FAMILY COUNSELING PLACE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SOLE MEMBER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | TYLER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BYRD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 402-917-7825 |
Mailing Address - Street 1: | 1710 N 144TH ST STE 4 |
Mailing Address - Street 2: | |
Mailing Address - City: | OMAHA |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68154-4715 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1710 N 144TH ST STE 4 |
Practice Address - Street 2: | |
Practice Address - City: | OMAHA |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68154-4715 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-915-1061 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-01-09 |
Last Update Date: | 2017-01-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 4758 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |