Provider Demographics
NPI:1700238441
Name:JEAN STUTO THERAPY LLC
Entity Type:Organization
Organization Name:JEAN STUTO THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:402-972-6049
Mailing Address - Street 1:3112 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3449
Mailing Address - Country:US
Mailing Address - Phone:402-972-6049
Mailing Address - Fax:
Practice Address - Street 1:3112 N 58TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3449
Practice Address - Country:US
Practice Address - Phone:402-972-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4682251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health