Provider Demographics
NPI:1033535224
Name:LOUDERBACK, THOMAS WILLIAM (PLMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:LOUDERBACK
Suffix:
Gender:M
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6021
Mailing Address - Country:US
Mailing Address - Phone:402-261-6667
Mailing Address - Fax:402-261-6526
Practice Address - Street 1:2110 S 38TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6021
Practice Address - Country:US
Practice Address - Phone:402-261-6667
Practice Address - Fax:402-261-6526
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1208101YA0400X
NE10200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)