Healthcare Provider Details

I. General information

NPI: 1215928908
Provider Name (Legal Business Name): THOMAS PATRICK BRENNAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 O ST SUITE 402
LINCOLN NE
68510-2468
US

IV. Provider business mailing address

7441 O ST SUITE 402
LINCOLN NE
68510-2468
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4215
  • Fax: 402-483-5228
Mailing address:
  • Phone: 402-483-4215
  • Fax: 402-483-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number180
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: