Provider Demographics
NPI:1831155357
Name:STORTVEDT, MARK E (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:STORTVEDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W NORFOLK AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5401
Mailing Address - Country:US
Mailing Address - Phone:402-379-2030
Mailing Address - Fax:402-379-3933
Practice Address - Street 1:333 W NORFOLK AVE
Practice Address - Street 2:STE 201
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5401
Practice Address - Country:US
Practice Address - Phone:402-379-2030
Practice Address - Fax:402-379-3933
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1769101YM0800X
101YP1600X
NE1243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84924OtherBC/BS INDIVIDUAL
NE92015OtherBC/BS SUPERVISOR
NE7893OtherMIDLANDS CHOICE
NE39189435426Medicaid