Individual
ASA NATHANAEL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4031 BURT ST, OMAHA, NE 68131-1837
(402) 800-5702
Mailing address
4031 BURT ST, OMAHA, NE 68131-1837
(402) 800-5702
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13264
NE
101YM0800X
Mental Health Counselor
XL3998
ME
Other
Enumeration date
12/18/2013
Last updated
07/23/2024
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