Provider Demographics
NPI:1649746306
Name:STEPHANIE SORUM LLC
Entity Type:Organization
Organization Name:STEPHANIE SORUM LLC
Other - Org Name:STEPHANIE SORUM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORUM
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-819-7510
Mailing Address - Street 1:17940 WELCH PLZ STE 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3714
Mailing Address - Country:US
Mailing Address - Phone:402-819-7510
Mailing Address - Fax:
Practice Address - Street 1:17940 WELCH PLZ STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3714
Practice Address - Country:US
Practice Address - Phone:402-819-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty