Healthcare Provider Details

I. General information

NPI: 1780356113
Provider Name (Legal Business Name): MIDWEST BRAIN TRAINING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 ARBOR ST STE 240D
OMAHA NE
68144-2979
US

IV. Provider business mailing address

2431 CRYSTAL CREEK DR
PAPILLION NE
68046-4665
US

V. Phone/Fax

Practice location:
  • Phone: 402-478-8758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CJ POOLE
Title or Position: OWNER
Credential: PLMHP
Phone: 402-478-8758