Provider Demographics
NPI:1982899431
Name:STOLTZ, LAURA L (LMHP, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2896
Mailing Address - Country:US
Mailing Address - Phone:402-371-9606
Mailing Address - Fax:
Practice Address - Street 1:900 RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2896
Practice Address - Country:US
Practice Address - Phone:402-371-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3613101YM0800X
NE1809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025541000Medicaid