Provider Demographics
NPI:1720420896
Name:FLOREZ, THOMAS BRIAN (LIMHP/LADC, CSOTS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRIAN
Last Name:FLOREZ
Suffix:
Gender:M
Credentials:LIMHP/LADC, CSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W 48TH ST STE 281
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1313
Mailing Address - Country:US
Mailing Address - Phone:308-370-1667
Mailing Address - Fax:
Practice Address - Street 1:416 W 48TH ST STE 28
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1314
Practice Address - Country:US
Practice Address - Phone:308-370-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1177101YA0400X
NE2110101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1177OtherLICENSE DRUG AND ALCOHOL
NE2110OtherINDEPENDENT MENTAL HEALTH LICENSURE