Provider Demographics
NPI:1316766249
Name:GITARI, BETTY MWENDE
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:MWENDE
Last Name:GITARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17007 HAWTHORNE CT APT 309
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2861
Mailing Address - Country:US
Mailing Address - Phone:402-378-5566
Mailing Address - Fax:
Practice Address - Street 1:5190 SPRAGUE PLZ # 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2886
Practice Address - Country:US
Practice Address - Phone:402-451-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2156101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)