Provider Demographics
NPI:1225179609
Name:HALLSTROM, DEBRA J (MS LIMHP LMHP LADC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:HALLSTROM
Suffix:
Gender:F
Credentials:MS LIMHP LMHP LADC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:J
Other - Last Name:MGGILL/ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2170 N PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2630
Mailing Address - Country:US
Mailing Address - Phone:402-720-8220
Mailing Address - Fax:402-753-6445
Practice Address - Street 1:2170 N PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2630
Practice Address - Country:US
Practice Address - Phone:402-720-8220
Practice Address - Fax:402-753-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health