Provider Demographics
NPI:1083037204
Name:SEMPEK, SHAWN (MHCTL)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:SEMPEK
Suffix:
Gender:M
Credentials:MHCTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2842
Mailing Address - Country:US
Mailing Address - Phone:712-307-6014
Mailing Address - Fax:712-307-6015
Practice Address - Street 1:118 N ELM ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:IA
Practice Address - Zip Code:51521-3510
Practice Address - Country:US
Practice Address - Phone:712-307-6014
Practice Address - Fax:712-307-6015
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health