Provider Demographics
NPI:1235225301
Name:STEPHENS, TERESA L (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2114 53RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-563-3967
Mailing Address - Fax:402-562-8666
Practice Address - Street 1:2314 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-562-8666
Practice Address - Fax:402-562-8666
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE916363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE267613Medicare ID - Type Unspecified