Provider Demographics
NPI:1134903545
Name:OMNI BLUE
Entity type:Organization
Organization Name:OMNI BLUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURALEE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:VARGO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ATR-BC, LPC
Authorized Official - Phone:724-953-1760
Mailing Address - Street 1:1110 RIDGE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1926
Mailing Address - Country:US
Mailing Address - Phone:724-953-1760
Mailing Address - Fax:
Practice Address - Street 1:1110 RIDGE AVE # 1
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1926
Practice Address - Country:US
Practice Address - Phone:724-953-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty