Healthcare Provider Details

I. General information

NPI: 1598160426
Provider Name (Legal Business Name): STEPHANIE HUCKINS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11605 ARBOR ST SUITE 106
OMAHA NE
68144-2982
US

IV. Provider business mailing address

5022 TRAIL CREEK AVE
BELLEVUE NE
68157-2255
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-4700
  • Fax: 402-330-8815
Mailing address:
  • Phone: 402-330-4700
  • Fax: 402-330-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1228
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1398
License Number StateNE

VIII. Authorized Official

Name: STEPHANIE A HUCKINS
Title or Position: OWNER
Credential: MSW, LIMHP
Phone: 402-330-4700