Provider Demographics
NPI:1518040849
Name:STAHLY-ROUSE, JOAN (LMHP, LPC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:STAHLY-ROUSE
Suffix:
Gender:F
Credentials:LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 NORMAL BLVD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2891
Mailing Address - Country:US
Mailing Address - Phone:402-560-1413
Mailing Address - Fax:402-261-8263
Practice Address - Street 1:4535 NORMAL BLVD
Practice Address - Street 2:SUITE 142
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2891
Practice Address - Country:US
Practice Address - Phone:402-560-1413
Practice Address - Fax:402-261-8263
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84234OtherBLUECROSS, BLUESHIELD
NE238325OtherMIDLAND CHOICE
NE337684OtherVALUEOPTIONS