Provider Demographics
NPI:1083424147
Name:AVANT, KAMARA LANAE (PLMHP)
Entity type:Individual
Prefix:
First Name:KAMARA
Middle Name:LANAE
Last Name:AVANT
Suffix:
Gender:
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2749
Mailing Address - Country:US
Mailing Address - Phone:402-885-5817
Mailing Address - Fax:
Practice Address - Street 1:3812 N 60TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2749
Practice Address - Country:US
Practice Address - Phone:402-885-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14203101YM0800X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health