Healthcare Provider Details

I. General information

NPI: 1720918964
Provider Name (Legal Business Name): OUR SQUARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 SPRAGUE ST
OMAHA NE
68104-2661
US

IV. Provider business mailing address

7076 BLONDO ST
OMAHA NE
68104-4667
US

V. Phone/Fax

Practice location:
  • Phone: 402-415-9217
  • Fax:
Mailing address:
  • Phone: 402-415-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: TASHA MCNEIL
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 402-415-9217