Provider Demographics
NPI:1740340595
Name:BLACK, SHEILA R (MS LMHP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:R
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LIFE OPTIONS COUNSELING 30 40 LAKE STREET
Mailing Address - Street 2:STE 118
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111
Mailing Address - Country:US
Mailing Address - Phone:402-612-4520
Mailing Address - Fax:402-614-2970
Practice Address - Street 1:3040 LAKE ST
Practice Address - Street 2:118
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3700
Practice Address - Country:US
Practice Address - Phone:402-612-4520
Practice Address - Fax:402-614-2970
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 2750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health