Basic Information
| Provider Information | |||||||||
| NPI: | 1093199788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMAR | ||||||||
| FirstName: | BRETT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 S 64TH PLZ APT 218 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681062856 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515034419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123221407 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 078410 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.