Healthcare Provider Details

I. General information

NPI: 1447802210
Provider Name (Legal Business Name): SAWYER BLAKE HARMON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 PINE ST
OMAHA NE
68106-2855
US

IV. Provider business mailing address

985450 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5450
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6418
  • Fax: 402-559-5737
Mailing address:
  • Phone: 402-559-8943
  • Fax: 402-559-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14828
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: