Healthcare Provider Details

I. General information

NPI: 1770285785
Provider Name (Legal Business Name): STEPHENSON PSYCHOTHERAPY AND ADDICTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 O ST STE 104
LINCOLN NE
68510-2468
US

IV. Provider business mailing address

7441 O ST STE 104
LINCOLN NE
68510-2468
US

V. Phone/Fax

Practice location:
  • Phone: 402-304-1248
  • Fax:
Mailing address:
  • Phone: 402-304-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE STEPHENSON
Title or Position: SOLE MEMBER
Credential: LIMHP, LADC, LPC
Phone: 402-304-1248