Basic Information
| Provider Information | |||||||||
| NPI: | 1205024155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OBRIST | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | LIMHP, LCSW, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4321 41ST AVENUE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686021028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025627500 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Practice Location | |||||||||
| Address1: | 4321 41ST AVENUE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686021028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025627500 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 05/26/2015 | ||||||||
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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 | 3251 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 1243 | NE | N | Behavioral Health & Social Service Providers | Social Worker | 363A00000X | 1664 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.