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NPI Code Detail

MEDICARE: TERA LANE STOKEBRAND PLMHP

MEDICARE: TERA LANE STOKEBRAND PLMHP
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
1101YM0800XMental Health Counselor9746NE

General Provider Information

NPI Number : 1588916829
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERA LANE STOKEBRAND PLMHP
Provider Business Mailing Address
First Line : 942 N 13TH ST
Second Line :
City : GENEVA
State : NE
Zip : 68361-1218
Country : US
Telephone Number : 402-230-9130
Fax Number : 402-759-3803
Provider Business Practice Location Address
First Line : 942 N 13TH ST
Second Line :
City : GENEVA
State : NE
Zip : 68361-1218
Country : US
Telephone Number : 402-230-9130
Fax Number : 402-759-3803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2012
Last Update Date : 02/25/2013

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Directions to “ TERA LANE STOKEBRAND PLMHP” Practice Location

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