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General NPI Number Information
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NPI Number | 1619081437
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Entity Type | Organization
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Legal Business Name | OMNE CLINIC, INC.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 101 N. FARWELL STREET STE. 204
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City | EAU CLAIRE
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State | WI
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Zip | 54703
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Country | US
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Telephone | 715-514-4600
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Fax | 715-514-4008
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Provider Business Mailing Address
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Address Line | 101 N. FARWELL STREET STE. 204
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City | EAU CLAIRE
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State | WI
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Zip | 54703
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Country | US
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Telephone | 715-514-4600
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Fax | 715-514-4008
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ANTON C SMETS
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Credential | PH.D, PSY.D.
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Telephone | 715-514-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 1720
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License Number State | WI
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