Provider Demographics
NPI:1053701615
Name:OBARA, HEATHER LYNN (PLADC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:OBARA
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:SELVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3402
Mailing Address - Country:US
Mailing Address - Phone:405-554-0520
Mailing Address - Fax:402-551-8797
Practice Address - Street 1:1490 N 16TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-4101
Practice Address - Country:US
Practice Address - Phone:402-827-0570
Practice Address - Fax:402-827-0577
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1266101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)