Provider Demographics
NPI:1669464806
Name:HOWARD, CANDACE TARA
Entity Type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:TARA
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 S 44TH ST
Mailing Address - Street 2:APT 111
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2841
Mailing Address - Country:US
Mailing Address - Phone:402-934-5655
Mailing Address - Fax:
Practice Address - Street 1:6720 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-3211
Practice Address - Country:US
Practice Address - Phone:402-457-7785
Practice Address - Fax:402-457-7791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELPC 1442101Y00000X
NELMHP 2706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health