Provider Demographics
NPI:1689496549
Name:GALLANT, BRANDON ARTHUR
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ARTHUR
Last Name:GALLANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 S 199TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-5061
Mailing Address - Country:US
Mailing Address - Phone:410-490-3538
Mailing Address - Fax:
Practice Address - Street 1:8601 W DODGE RD STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3430
Practice Address - Country:US
Practice Address - Phone:402-916-4545
Practice Address - Fax:531-213-4131
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health