Basic Information
| Provider Information | |||||||||
| NPI: | 1245363118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAIMAH | ||||||||
| FirstName: | R JUSTICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHD, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10306 ELLISON CIR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681341024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025154874 | ||||||||
| FaxNumber: | 4023448089 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 S 42ND ST | ||||||||
| Address2: | SUITE 538 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681052939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023447000 | ||||||||
| FaxNumber: | 4023448089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7948 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.