Provider Demographics
NPI:1659719474
Name:ROSENTRATER, SHANNA ELIZABETH (MA, LIMHP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:ELIZABETH
Last Name:ROSENTRATER
Suffix:
Gender:F
Credentials:MA, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2534
Mailing Address - Country:US
Mailing Address - Phone:308-760-9776
Mailing Address - Fax:
Practice Address - Street 1:4215 AVENUE I
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4902
Practice Address - Country:US
Practice Address - Phone:308-635-3696
Practice Address - Fax:308-635-0680
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4591101YM0800X
NE9932101YM0800X
NE3437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health