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11550 I St Ste 100 Omaha NE 68137-1222 | |
| (402) 498-4700 | |
| (402) 493-3340 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11550 I St Ste 100, Omaha, Nebraska |
| Authorized Official Name and Position | Ashley Dawn Brown (PRESIDENT) |
| Authorized Official Contact | 4024984700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11550 I St Ste 100 Omaha NE 68137-1222 Ph: (402) 498-4700 | 11550 I St Ste 100 Omaha NE 68137-1222 Ph: (402) 498-4700 |
| NPI Number | 1912235458 |
|---|---|
| Provider Enumeration Date | 11/20/2009 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 9739624354 |
|---|---|
| Medicare Enrollment ID | O20240708003054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912235458 | NPI | - | NPPES |
| 10025836700 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Gloria Christian |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801353966 PECOS PAC ID: 7012452642 Enrollment ID: I20240708003372 |
| Provider Name | Kathleen L Mapes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194085696 PECOS PAC ID: 7416489745 Enrollment ID: I20241011001730 |
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