Provider Demographics
NPI:1891942132
Name:DIRKS, TAMARA JO (PLMHP LADC ICADC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JO
Last Name:DIRKS
Suffix:
Gender:F
Credentials:PLMHP LADC ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4002
Mailing Address - Country:US
Mailing Address - Phone:888-601-5553
Mailing Address - Fax:402-475-7541
Practice Address - Street 1:2109 S 24TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4002
Practice Address - Country:US
Practice Address - Phone:888-601-5553
Practice Address - Fax:402-475-7541
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-553101YM0800X
NE8651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96118OtherBCBS
NE96118OtherBCBS