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General NPI Number Information
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NPI Number | 1023927068
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Entity Type | Individual
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Provider Name | BROCK MASSEY
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Gender | Male
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 11717 BURT ST STE 203
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City | OMAHA
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State | NE
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Zip | 68154-1500
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Country | US
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Telephone | 402-302-2775
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Fax | 833-471-4570
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Provider Business Mailing Address
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Address Line | 11717 BURT ST STE 203
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City | OMAHA
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State | NE
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Zip | 68154-1500
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Country | US
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Telephone | 402-302-2775
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Fax | 833-471-4570
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 15061
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 8422
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License Number State | NE
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