Provider Demographics
NPI:1598160426
Name:STEPHANIE HUCKINS LLC
Entity Type:Organization
Organization Name:STEPHANIE HUCKINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUCKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LIMHP
Authorized Official - Phone:402-330-4700
Mailing Address - Street 1:5022 TRAIL CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68157-2255
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1228101YM0800X
NE1398104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty