Provider Demographics
NPI:1285857581
Name:STARA, CHERYL JEANNE (LMHP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JEANNE
Last Name:STARA
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3547
Mailing Address - Country:US
Mailing Address - Phone:402-540-8598
Mailing Address - Fax:402-486-3118
Practice Address - Street 1:1131 VAN DORN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3547
Practice Address - Country:US
Practice Address - Phone:402-540-8598
Practice Address - Fax:402-486-3118
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251511-00Medicaid