Omni Behavioral Services

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

OMNI BEHAVIORAL SERVICES

Doing business as

Omni Behavioral Services

Practice address

209 Martin Luther King Jr. Dr.
Elizabethtown, NC 28337-2833

Phone

(910) 247-6822

Fax

(910) 247-6829

NPI assigned

Oct 28, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John A Jackson

Title

Senior Administrator

Phone

(910) 247-6822

Specialties & licenses 1

Addresses

Other names 1

• Omni Behavioral Services Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tara L Govan, LCAS 1917

  • Addiction (Substance Use Disorder) Counselor
  • Elizabethtown, NC
  • NPI 1740823228
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572220800000",
    "number": "1083257562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 MARTIN LUTHER KING JR. DR.",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "28352",
            "telephone_number": "910-247-6822",
            "fax_number": "910-247-6829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 MARTIN LUTHER KING JR. DR.",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283372833",
            "telephone_number": "910-247-6822",
            "fax_number": "910-247-6829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI BEHAVIORAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2019-10-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SENIOR ADMINISTRATOR",
        "authorized_official_telephone_number": "910-247-6822"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Elizabethtown, NC
• Providers in Elizabethtown, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.