Healthcare Provider Details

I. General information

NPI: 1649704685
Provider Name (Legal Business Name): TIMOTHY TERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 N 24TH ST STE 223
OMAHA NE
68110-2279
US

IV. Provider business mailing address

2505 N 24TH ST STE 223
OMAHA NE
68110-2279
US

V. Phone/Fax

Practice location:
  • Phone: 402-451-5549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: