Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 3164 | NE |
N | 101YP2500X | Professional Counselor | 1639 | NE |
NPI | 1003886458 |
---|---|
Provider Name | Mrs. Sheryl R Blaha |
First Address | Ord, NE 68862-1762 |
Second Address | Ord, NE 68862-1762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 20/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47077781326 | (05) | NE |