Provider Demographics
NPI:1154332831
Name:STORMBERG, JEFFREY LOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LOY
Last Name:STORMBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 FARNAM STREET
Mailing Address - Street 2:STE 215
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5759
Mailing Address - Country:US
Mailing Address - Phone:402-393-0642
Mailing Address - Fax:402-391-2641
Practice Address - Street 1:1403 FARNAM ST
Practice Address - Street 2:STE 215
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2200
Practice Address - Country:US
Practice Address - Phone:402-393-0642
Practice Address - Fax:402-391-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6223012OtherUNITED BEHAVIORAL HEALTH
NE84418OtherBC/BS PROVIDER NUMBER
NE472928000OtherMAGELLAN MIS NUMBER