Provider Demographics
NPI:1538512876
Name:AMY JOHANNA SJOHOLM, LLC
Entity Type:Organization
Organization Name:AMY JOHANNA SJOHOLM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:SJOHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-879-5755
Mailing Address - Street 1:106 PARKLANE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-1844
Mailing Address - Country:US
Mailing Address - Phone:402-879-5755
Mailing Address - Fax:
Practice Address - Street 1:3308 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1333
Practice Address - Country:US
Practice Address - Phone:402-879-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026475600Medicaid