Basic Information
| Provider Information | |||||||||
| NPI: | 1144387267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEBRANK | ||||||||
| FirstName: | IDA MARIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LADC LIMHP CMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8715 OAK ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681243051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023330898 | ||||||||
| FaxNumber: | 4023330988 | ||||||||
| Practice Location | |||||||||
| Address1: | 8715 OAK ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681243051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023330898 | ||||||||
| FaxNumber: | 4023330988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 679 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 884 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 1297 | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.