Healthcare Provider Details

I. General information

NPI: 1477138147
Provider Name (Legal Business Name): TIFFANY LASSEK PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11717 S PLZ APT 111
OMAHA NE
68137-3980
US

IV. Provider business mailing address

11717 S PLZ APT 111
OMAHA NE
68137-3980
US

V. Phone/Fax

Practice location:
  • Phone: 140-261-2289
  • Fax:
Mailing address:
  • Phone: 402-612-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12310
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7512
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: