Doctor Name: | BRETT OMAR |
NPI Number: | 1093199788 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 078410 |
Business Practice Address: | 515 E Broadway Council Bluffs, IA - 515034419 |
Business Phone Number: | 7123221407 |
Business Fax Number: | |
Mailing Address: | 2211 S 64th Plz Apt 218, OMAHA |
State: | NE |
Postal Code: | 681062856 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/13/2015 |
NPI Last Update Date: | 07/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 078410 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |