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NPI Code Detail

MEDICARE: MS. KATHY DEE TEJCKA LMHP, MSW

MEDICARE: MS. KATHY DEE TEJCKA LMHP, MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1124466503
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHY DEE TEJCKA LMHP, MSW
Provider Business Mailing Address
First Line : 290 IOOF AVE
Second Line :
City : GILROY
State : CA
Zip : 95020-5204
Country : US
Telephone Number : 408-846-2100
Fax Number :
Provider Business Practice Location Address
First Line : 245 S 84TH ST STE L101
Second Line :
City : LINCOLN
State : NE
Zip : 68510-2601
Country : US
Telephone Number : 402-327-0017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2013
Last Update Date : 06/24/2020

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