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General NPI Number Information
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NPI Number | 1508328733
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Entity Type | Organization
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Legal Business Name | IM HEBRANK PSYCHOTHERAPY
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 1406 FORT CROOK RD S STE 401
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City | BELLEVUE
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State | NE
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Zip | 68005-2980
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Country | US
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Telephone | 402-541-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 FORT CROOK RD S STE 401
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City | BELLEVUE
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State | NE
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Zip | 68005-2980
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Country | US
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Telephone | 402-541-9698
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IDA MARIE HEBRANK
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Credential | LIMHP, CMSW, LADC
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Telephone | 402-541-9698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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