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General NPI Number Information
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NPI Number | 1538512876
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Entity Type | Organization
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Legal Business Name | AMY JOHANNA SJOHOLM, LLC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 3308 W CAPITAL AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-1333
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Country | US
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Telephone | 402-879-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 106 PARKLANE AVE
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City | AURORA
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State | NE
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Zip | 68818-1844
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Country | US
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Telephone | 402-879-5755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY JOHANNA SJOHOLM
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Credential | LMHP
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Telephone | 402-879-5755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4454
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License Number State | NE
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