Healthcare Provider Details

I. General information

NPI: 1356834162
Provider Name (Legal Business Name): MICHAEL AUSTIN REMINGTON PLADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W 23RD ST STE E
FREMONT NE
68025-1211
US

IV. Provider business mailing address

1941 S 42ND ST STE 328
OMAHA NE
68105-2943
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-1592
  • Fax: 402-727-4288
Mailing address:
  • Phone: 402-614-8444
  • Fax: 402-614-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1571
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: