Provider Demographics
NPI:1114166444
Name:STEVENSON, SANDY S (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:S
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 LUCILLE DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68147-2505
Mailing Address - Country:US
Mailing Address - Phone:402-715-0296
Mailing Address - Fax:
Practice Address - Street 1:708 FORT CROOK RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4558
Practice Address - Country:US
Practice Address - Phone:402-715-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1472101YA0400X
NE1273101YA0400X
NE3680101YM0800X
NE2998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty