Provider Demographics
NPI:1003886458
Name:BLAHA, SHERYL R (MS LMHP, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:R
Last Name:BLAHA
Suffix:
Gender:F
Credentials:MS LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 14TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1762
Mailing Address - Country:US
Mailing Address - Phone:308-730-1245
Mailing Address - Fax:
Practice Address - Street 1:314 S 14TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1762
Practice Address - Country:US
Practice Address - Phone:308-730-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1639101YP2500X
NE3164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077781326Medicaid
098125Medicare ID - Type Unspecified