Provider Demographics
NPI:1548306806
Name:TAVERAS, OMAR FLORES (LMFT)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:FLORES
Last Name:TAVERAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:FLORES
Other - Last Name:TAVERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:106 MICHELE TER
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3924
Mailing Address - Country:US
Mailing Address - Phone:229-200-6524
Mailing Address - Fax:
Practice Address - Street 1:110 KELLWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3263
Practice Address - Country:US
Practice Address - Phone:229-200-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000887101Y00000X
GA000887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor