Provider Demographics
NPI:1205868692
Name:HEIM, SHONA E (MA LMHP CSW)
Entity type:Individual
Prefix:
First Name:SHONA
Middle Name:E
Last Name:HEIM
Suffix:
Gender:F
Credentials:MA LMHP CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-2412
Mailing Address - Country:US
Mailing Address - Phone:308-284-6767
Mailing Address - Fax:308-284-3084
Practice Address - Street 1:401 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2412
Practice Address - Country:US
Practice Address - Phone:308-284-6767
Practice Address - Fax:308-284-3084
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5110OtherMIDLANDS CHOICE
84091OtherBCBS DIRECT PROVIDER
97086OtherBCBS AUXILLIARY PROVIDER