Provider Demographics
NPI:1063214740
Name:THEIS, AMY J (LMHP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:THEIS
Suffix:
Gender:
Credentials:LMHP
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 947
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-0947
Mailing Address - Country:US
Mailing Address - Phone:402-563-7060
Mailing Address - Fax:402-563-7065
Practice Address - Street 1:2200 26TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2614
Practice Address - Country:US
Practice Address - Phone:402-563-7060
Practice Address - Fax:402-563-7065
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health