=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972583987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETTE LOU TARRANT CLINICAL SOCIAL WORK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2006
-----------------------------------------------------
Last Update Date | 09/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11414 WEST CENTER ROAD #233
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-960-0192
-----------------------------------------------------
Fax | 402-502-9538
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1039 S. 106TH PLAZA #302
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68114-4773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-960-0192
-----------------------------------------------------
Fax | 402-502-9538
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 278
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------