Provider Demographics
NPI:1912193897
Name:HEPBURN, GREGORY NATHANIEL JR (MS, PLMHP)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:NATHANIEL
Last Name:HEPBURN
Suffix:JR
Gender:M
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 N 115TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1467
Mailing Address - Country:US
Mailing Address - Phone:402-658-3250
Mailing Address - Fax:402-502-3637
Practice Address - Street 1:7176 N 51ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2451
Practice Address - Country:US
Practice Address - Phone:402-933-8656
Practice Address - Fax:402-573-0772
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health