Basic Information
| Provider Information | |||||||||
| NPI: | 1174043749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLINAN | ||||||||
| FirstName: | BRET | ||||||||
| MiddleName: | DONOVAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, PCMSW, PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5115 F ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681172807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979866 | ||||||||
| FaxNumber: | 4023971404 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024743322 | ||||||||
| FaxNumber: | 4024744668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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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 | 11213 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.