Healthcare Provider Details

I. General information

NPI: 1669554820
Provider Name (Legal Business Name): TERRY LOU FISHER-EDENS LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 10TH ST
GERING NE
69361-2417
US

IV. Provider business mailing address

2027 10TH ST
GERING NE
69341-2417
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-4200
  • Fax: 308-632-4205
Mailing address:
  • Phone: 308-632-4200
  • Fax: 308-632-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2977
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1541
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: