Provider Demographics
NPI:1497459333
Name:JEA THEIS THERAPY, LLC
Entity Type:Organization
Organization Name:JEA THEIS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:JEA
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LIMHP
Authorized Official - Phone:531-444-9700
Mailing Address - Street 1:3031 S 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3042
Mailing Address - Country:US
Mailing Address - Phone:402-201-4195
Mailing Address - Fax:402-763-4492
Practice Address - Street 1:3031 S 87TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3042
Practice Address - Country:US
Practice Address - Phone:402-201-4195
Practice Address - Fax:402-763-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty