| Renewed Vision Counseling And Developmental Disability Center Pc | |
|
4610 S. 133rd St Suite 106 Omaha NE 68137-1133 | |
| (402) 275-6413 | |
| Not Available |
| Full Name | Renewed Vision Counseling And Developmental Disability Center Pc |
|---|---|
| Speciality | Counselor |
| Location | 4610 S. 133rd St, Omaha, Nebraska |
| Authorized Official Name and Position | Christopher Marshall (OWNER) |
| Authorized Official Contact | 5318767455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Vision Counseling And Developmental Disability Center Pc 4642 S. 132nd St Omaha NE 68137-1764 Ph: (531) 876-7455 | Renewed Vision Counseling And Developmental Disability Center Pc 4610 S. 133rd St Suite 106 Omaha NE 68137-1133 Ph: (402) 275-6413 |
| NPI Number | 1174122170 |
|---|---|
| Provider Enumeration Date | 10/21/2020 |
| Last Update Date | 02/26/2025 |
| Certification Date | 07/02/2021 |
| Medicare PECOS PAC ID | 1658892914 |
|---|---|
| Medicare Enrollment ID | O20250304001307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174122170 | NPI | - | NPPES |
| Provider Name | Marquetta Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487127742 PECOS PAC ID: 6901131002 Enrollment ID: I20190711002069 |
| Provider Name | Vivian Mosier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841811874 PECOS PAC ID: 7810426046 Enrollment ID: I20250131003153 |
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