Provider Demographics
NPI:1487445128
Name:BRAUN, LISA GILLIN (CLDS CERTIFICATION)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GILLIN
Last Name:BRAUN
Suffix:
Gender:F
Credentials:CLDS CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 S 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1012
Mailing Address - Country:US
Mailing Address - Phone:402-637-6328
Mailing Address - Fax:
Practice Address - Street 1:1526 S 105TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1012
Practice Address - Country:US
Practice Address - Phone:402-637-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106E00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty