Provider Demographics
NPI:1114361821
Name:WALTHER, STEPHANIE (MA, PLMHP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3606
Mailing Address - Country:US
Mailing Address - Phone:402-474-3322
Mailing Address - Fax:402-474-4668
Practice Address - Street 1:2300 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3606
Practice Address - Country:US
Practice Address - Phone:402-474-3322
Practice Address - Fax:402-474-4668
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health