Provider Demographics
NPI:1356859698
Name:SBEVINGTON'S MENTAL HEALTH THERAPY
Entity Type:Organization
Organization Name:SBEVINGTON'S MENTAL HEALTH THERAPY
Other - Org Name:SBEVINGTON'S MENTAL HEALTH THERAPIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BEVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:402-686-4122
Mailing Address - Street 1:5519NORTHWEST RADIAL HIGHWAY
Mailing Address - Street 2:5519NORTHWEST RADIAL HIGHWAY SUITE3
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:402-686-4122
Mailing Address - Fax:
Practice Address - Street 1:5519NORTHWEST RADIAL HIGHWAY
Practice Address - Street 2:5519NORTHWEST RADIAL HIGHWAY SUITE3
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104
Practice Address - Country:US
Practice Address - Phone:402-686-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty