Provider Demographics
NPI:1669568879
Name:SHERIDAN, LISA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4094
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-0094
Mailing Address - Country:US
Mailing Address - Phone:402-951-3066
Mailing Address - Fax:402-951-3078
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:402-206-4120
Practice Address - Fax:503-253-7659
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE734101YP2500X
NE3352101YM0800X
NE1704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health