Healthcare Provider Details
I. General information
NPI: 1427413343
Provider Name (Legal Business Name): SHAWNA CIUREJ MS, LMHP, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/18/2015
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8610 BRENTWOOD DR SUITE 1
LA VISTA NE
68128-3377
US
IV. Provider business mailing address
705 N 16TH ST
COUNCIL BLUFFS IA
51501-0105
US
V. Phone/Fax
- Phone: 402-331-3232
- Fax:
- Phone: 402-690-2716
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 10748 |
| License Number State | NE |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: