Healthcare Provider Details

I. General information

NPI: 1275479628
Provider Name (Legal Business Name): DAVID MICHAEL DEBOLT PLADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 TAYLOR CIR
OMAHA NE
68104-2673
US

IV. Provider business mailing address

6310 TAYLOR CIR
OMAHA NE
68104-2673
US

V. Phone/Fax

Practice location:
  • Phone: 402-812-7389
  • Fax:
Mailing address:
  • Phone: 402-812-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2347
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: