Individual
BEAU ANTHONY CADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLMHP
Contact information
Practice address
15705 W. DODGE ROAD, SUITE 102, OMAHA, NE 68118
(402) 575-5577
Mailing address
2835 S 107TH AVE, OMAHA, NE 68124-2445
(712) 216-0164
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13318
NE
Other
Enumeration date
02/20/2023
Last updated
03/07/2023
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