Provider Demographics
NPI:1447009261
Name:BEJARANO, ANDREA (MS, PLMHP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BEJARANO
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7561 S 146TH ST APT 3313
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-6930
Mailing Address - Country:US
Mailing Address - Phone:305-498-7320
Mailing Address - Fax:
Practice Address - Street 1:11414 W CENTER RD STE 247
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4420
Practice Address - Country:US
Practice Address - Phone:402-598-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health