Provider Demographics
NPI:1508913864
Name:CUSICK-BROWN, COLEEN K (CMSW, LMHP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:K
Last Name:CUSICK-BROWN
Suffix:
Gender:F
Credentials:CMSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N 90TH ST STE 200
Mailing Address - Street 2:CHILDREN'S BEHAVIORAL HEALTH
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2766
Mailing Address - Country:US
Mailing Address - Phone:402-955-3900
Mailing Address - Fax:402-955-3920
Practice Address - Street 1:1000 N 90TH ST
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2764
Practice Address - Country:US
Practice Address - Phone:402-955-3900
Practice Address - Fax:402-955-3920
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6255838OtherUNITED BEHAVIORAL HEALTH
12575OtherMIDLANDS CHOICE
NE84365OtherBCBS