Healthcare Provider Details

I. General information

NPI: 1205868692
Provider Name (Legal Business Name): SHONA E HEIM MA LMHP CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W 1ST ST
OGALLALA NE
69153-2412
US

IV. Provider business mailing address

401 W 1ST ST
OGALLALA NE
69153-2412
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-6767
  • Fax: 308-284-3084
Mailing address:
  • Phone: 308-284-6767
  • Fax: 308-284-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number435
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: