Provider Demographics
NPI:1760914204
Name:SERVANTS OF MARY
Entity Type:Organization
Organization Name:SERVANTS OF MARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THEARPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-951-3066
Mailing Address - Street 1:7400 MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3351
Mailing Address - Country:US
Mailing Address - Phone:402-206-4120
Mailing Address - Fax:
Practice Address - Street 1:7400 MILITARY AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3351
Practice Address - Country:US
Practice Address - Phone:402-951-3066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty