Provider Demographics
NPI:1730212168
Name:O'HALLORAN, THERESA M (EDD, LIMHP, CPC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:EDD, LIMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12822 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3733
Mailing Address - Country:US
Mailing Address - Phone:402-403-0190
Mailing Address - Fax:402-932-4121
Practice Address - Street 1:12822 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3733
Practice Address - Country:US
Practice Address - Phone:402-403-0190
Practice Address - Fax:402-932-4121
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1584101YP2500X
NE679101YM0800X
CO193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025627300Medicaid