Individual
MS. GLENETTA R BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, PMHP
Contact information
Practice address
3040 LAKE ST STE 118, OMAHA, NE 68111-3700
(402) 215-3433
(402) 445-4498
Mailing address
3040 LAKE ST STE 118, OMAHA, NE 68111-3700
(402) 215-3433
(402) 445-4498
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9886
NE
Other
Enumeration date
02/08/2013
Last updated
02/08/2013
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