Healthcare Provider Details

I. General information

NPI: 1477844876
Provider Name (Legal Business Name): WENDY JEA THEIS LIMHP, LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 PACIFIC ST SUITE 304
OMAHA NE
68114-5428
US

IV. Provider business mailing address

7602 PACIFIC ST SUITE 304
OMAHA NE
68114-5428
US

V. Phone/Fax

Practice location:
  • Phone: 701-240-7033
  • Fax: 701-240-7033
Mailing address:
  • Phone: 701-240-7033
  • Fax: 701-240-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1383
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1444
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007669
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: