Healthcare Provider Details

I. General information

NPI: 1982386934
Provider Name (Legal Business Name): CRYSTAL BRIANNE HOLES PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 12TH ST
NORTH PLATTE NE
69101-2365
US

IV. Provider business mailing address

7929 W CENTER RD
OMAHA NE
68124-3104
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-0587
  • Fax: 308-532-0653
Mailing address:
  • Phone: 877-518-1070
  • Fax: 402-591-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13467
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: