Provider Demographics
NPI:1154461929
Name:FELDMAN, THERESA KAY (LMHP, LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:LMHP, LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3828
Mailing Address - Country:US
Mailing Address - Phone:308-532-0777
Mailing Address - Fax:
Practice Address - Street 1:308 W 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3828
Practice Address - Country:US
Practice Address - Phone:308-532-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2999101YM0800X
NE736101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025721900Medicaid