Provider Demographics
NPI:1891342408
Name:PETEREIT, TESSA (EDS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:
Last Name:PETEREIT
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-1909
Mailing Address - Country:US
Mailing Address - Phone:402-826-7780
Mailing Address - Fax:
Practice Address - Street 1:1750 IRIS AVE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-1909
Practice Address - Country:US
Practice Address - Phone:402-826-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool