Provider Demographics
NPI:1558040998
Name:MOMCHILOVICH, BRIANA MARIE (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MARIE
Last Name:MOMCHILOVICH
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:BRI
Other - Middle Name:MARIE
Other - Last Name:MOMCHILOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1011 N 192ND CT APT 226
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 N 192ND CT APT 226
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2965
Practice Address - Country:US
Practice Address - Phone:651-324-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool