Provider Demographics
NPI:1689440570
Name:CRARY, CASEY E
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:E
Last Name:CRARY
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 1:5906 S 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2813
Mailing Address - Country:US
Mailing Address - Phone:402-812-5975
Mailing Address - Fax:402-891-8860
Practice Address - Street 1:5906 S 169TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-2813
Practice Address - Country:US
Practice Address - Phone:402-812-5975
Practice Address - Fax:402-891-8860
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-313822106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-23-313822OtherBACB