| Revision Psychotherapy Llc | |
|
1055 N 115th St Ste 105 Omaha NE 68154-4419 | |
| (402) 312-0919 | |
| Not Available |
| Full Name | Revision Psychotherapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 1055 N 115th St Ste 105, Omaha, Nebraska |
| Authorized Official Name and Position | Laurelin Prinell Sterns (INDEPENDENT MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 4023120919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revision Psychotherapy Llc 16655 Dora Hamann Pkwy Omaha NE 68116-2303 Ph: (402) 312-0919 | Revision Psychotherapy Llc 1055 N 115th St Ste 105 Omaha NE 68154-4419 Ph: (402) 312-0919 |
| NPI Number | 1770353625 |
|---|---|
| Provider Enumeration Date | 01/02/2024 |
| Last Update Date | 01/02/2024 |
| Certification Date | 01/02/2024 |
| Medicare PECOS PAC ID | 2567993876 |
|---|---|
| Medicare Enrollment ID | O20240926004194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770353625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Laurelin P Sterns |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952890022 PECOS PAC ID: 4082147228 Enrollment ID: I20240926000643 |
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