Provider Demographics
NPI:1730896978
Name:UNIVERSE, ANYA MARIE (MSC, PLMHP)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:MARIE
Last Name:UNIVERSE
Suffix:
Gender:F
Credentials:MSC, PLMHP
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:MARIE
Other - Last Name:COLBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:8013 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1647
Mailing Address - Country:US
Mailing Address - Phone:402-446-0215
Mailing Address - Fax:
Practice Address - Street 1:11404 W DODGE RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-9603
Practice Address - Country:US
Practice Address - Phone:402-512-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health