Healthcare Provider Details

I. General information

NPI: 1083446066
Provider Name (Legal Business Name): CONNECTIVE COLLECTIVE COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 S 42ND ST STE 506
OMAHA NE
68105-2945
US

IV. Provider business mailing address

1941 S 42ND ST STE 506
OMAHA NE
68105-2945
US

V. Phone/Fax

Practice location:
  • Phone: 840-215-9329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE FRANCOISE BRAGGS
Title or Position: OWNER/MENTAL HEALTH PRACTITIONER
Credential:
Phone: 840-215-9329