Provider Demographics
NPI:1447579313
Name:TIEGS, THOMAS J (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TIEGS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 FALLBROOK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4643
Mailing Address - Country:US
Mailing Address - Phone:402-875-0632
Mailing Address - Fax:
Practice Address - Street 1:755 FALLBROOK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4643
Practice Address - Country:US
Practice Address - Phone:402-875-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE747103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025071300Medicaid