Healthcare Provider Details

I. General information

NPI: 1619486404
Provider Name (Legal Business Name): OMNI BEHAVIORAL HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W MAIN ST
FREEHOLD NJ
07728-2144
US

IV. Provider business mailing address

PO BOX 6902
FREEHOLD NJ
07728-6902
US

V. Phone/Fax

Practice location:
  • Phone: 732-766-6067
  • Fax: 732-791-1408
Mailing address:
  • Phone: 732-766-6067
  • Fax: 732-791-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00382200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00268300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK FLESCHER
Title or Position: CEO
Credential: PH.D.
Phone: 732-766-6067