Basic Information
| Provider Information | |||||||||
| NPI: | 1588004352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STALZER | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | RICHELLE | ||||||||
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| Credential: | PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 N 60TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681043402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025540520 | ||||||||
| FaxNumber: | 4025518797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1214 HIGHWAY S71 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501388837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206083555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2001797 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 114451 | IA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 1472 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 9973 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.