Healthcare Provider Details

I. General information

NPI: 1790988897
Provider Name (Legal Business Name): SEAN S. HALEY M.S., N.C.C., PLMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 W CENTER RD SUITE 220
OMAHA NE
68144-4486
US

IV. Provider business mailing address

11414 W CENTER RD SUITE 220
OMAHA NE
68144-4486
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-4014
  • Fax: 402-334-2930
Mailing address:
  • Phone: 402-330-4014
  • Fax: 402-334-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8335
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8335
Identifier TypeOTHER
Identifier StateNE
Identifier IssuerPLMHP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: