Provider Demographics
NPI:1316457724
Name:DREAM AGAIN THERAPY, LLC
Entity type:Organization
Organization Name:DREAM AGAIN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-639-1013
Mailing Address - Street 1:1111 N 13TH ST STE 142A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-4250
Mailing Address - Country:US
Mailing Address - Phone:402-207-2517
Mailing Address - Fax:877-274-6838
Practice Address - Street 1:1111 N 13TH ST STE 142A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-4250
Practice Address - Country:US
Practice Address - Phone:402-207-2517
Practice Address - Fax:877-274-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty