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General NPI Number Information
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NPI Number | 1750654166
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Entity Type | Organization
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Legal Business Name | FALLBROOK BEHAVIORAL HEALTH, PC
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 755 FALLBROOK BLVD STE 100
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City | LINCOLN
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State | NE
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Zip | 68521-4637
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Country | US
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Telephone | 402-875-0632
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Fax | 402-438-2107
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Provider Business Mailing Address
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Address Line | 755 FALLBROOK BLVD STE 100
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City | LINCOLN
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State | NE
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Zip | 68521-4637
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Country | US
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Telephone | 402-875-0632
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Fax | 402-438-2107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS J TIEGS
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Credential | PHD
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Telephone | 402-875-0632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 747
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License Number State | NE
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