Provider Demographics
NPI:1366634289
Name:EVERT, STACEY (PLHMP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:EVERT
Suffix:
Gender:F
Credentials:PLHMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 ARBOR ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2982
Mailing Address - Country:US
Mailing Address - Phone:402-330-4700
Mailing Address - Fax:402-330-8815
Practice Address - Street 1:11605 ARBOR ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2982
Practice Address - Country:US
Practice Address - Phone:402-330-4700
Practice Address - Fax:402-330-8815
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health