Provider Demographics
NPI:1326883778
Name:PORTWOOD, STEPHANIE CELESTE (PLMHP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CELESTE
Last Name:PORTWOOD
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 N 151ST CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1569
Mailing Address - Country:US
Mailing Address - Phone:801-647-8456
Mailing Address - Fax:
Practice Address - Street 1:3520 N 163RD PLZ STE 6
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2109
Practice Address - Country:US
Practice Address - Phone:402-513-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health