Provider Demographics
NPI:1659926988
Name:GRUBER, THOMAS MARTIN JR
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARTIN
Last Name:GRUBER
Suffix:JR
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 1:8218 N 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-7044
Mailing Address - Country:US
Mailing Address - Phone:402-699-2801
Mailing Address - Fax:
Practice Address - Street 1:8218 N 149TH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-7044
Practice Address - Country:US
Practice Address - Phone:402-699-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health