Healthcare Provider Details

I. General information

NPI: 1669557765
Provider Name (Legal Business Name): TORRI SMITH TEJRAL IMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N ADAMS ST STE 7
PAPILLION NE
68046-3111
US

IV. Provider business mailing address

8538 S 100TH ST
LA VISTA NE
68128-3072
US

V. Phone/Fax

Practice location:
  • Phone: 402-916-4539
  • Fax:
Mailing address:
  • Phone: 402-525-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number99
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-05-2443
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: