Healthcare Provider Details

I. General information

NPI: 1215480165
Provider Name (Legal Business Name): SUSAN M SHIELDS LIMHP, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 W BROADWAY
COUNCIL BLUFFS IA
51501-3310
US

IV. Provider business mailing address

9430 HIMEBAUGH CIR
OMAHA NE
68134-1600
US

V. Phone/Fax

Practice location:
  • Phone: 712-276-9000
  • Fax: 712-276-4917
Mailing address:
  • Phone: 402-651-3809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number093854
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: