Healthcare Provider Details

I. General information

NPI: 1417499856
Provider Name (Legal Business Name): TIFFANY HOHWIELER EVANS MS, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 N 185TH ST
ELKHORN NE
68022-7124
US

IV. Provider business mailing address

5321 S 138TH ST
OMAHA NE
68137-2913
US

V. Phone/Fax

Practice location:
  • Phone: 402-212-4836
  • Fax:
Mailing address:
  • Phone: 402-895-4000
  • Fax: 866-895-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2075
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2333
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: