Healthcare Provider Details

I. General information

NPI: 1649661521
Provider Name (Legal Business Name): MERRIEL A CONDE, CMSW, LMHP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6107 MAPLE ST SUITE B
OMAHA NE
68104-4001
US

IV. Provider business mailing address

6107 MAPLE ST SUITE B
OMAHA NE
68104-4001
US

V. Phone/Fax

Practice location:
  • Phone: 402-810-5589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number338
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1038
License Number StateNE

VIII. Authorized Official

Name: MERRIEL CONDE
Title or Position: OWNER
Credential: CMSW, LIMHP
Phone: 402-810-5589