MEDICARE: MRS. TERESA L STEPHENS LMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	916	NE

General Provider Information

NPI Number	:	1235225301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA L STEPHENS LMHP

Provider Business Mailing Address
First Line	:	2114 53RD ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601
Country	:	US
Telephone Number	:	402-563-3967
Fax Number	:	402-562-8666

Provider Business Practice Location Address
First Line	:	2314 13TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601
Country	:	US
Telephone Number	:	402-562-8666
Fax Number	:	402-562-8666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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