Basic Information
| Provider Information | |||||||||
| NPI: | 1184195760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMILEE L. O'BRIEN LICSW LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1705 G. STREET | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027688491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1320 G ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 683612104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027688491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2018 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | O'BRIEN | ||||||||
| AuthorizedOfficialFirstName: | EMILEE | ||||||||
| AuthorizedOfficialMiddleName: | LAUREN | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 4027688491 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1932625647 | 01 | NE | BCBS | OTHER | 1932625647 | 05 | NE | MEDICAID |