Provider Demographics
NPI:1972196053
Name:PENGUIN PLACE COUNSELING, LLC
Entity Type:Organization
Organization Name:PENGUIN PLACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAVY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:402-580-5282
Mailing Address - Street 1:770 N COTNER BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2342
Mailing Address - Country:US
Mailing Address - Phone:402-580-4282
Mailing Address - Fax:531-229-0351
Practice Address - Street 1:770 N COTNER BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2342
Practice Address - Country:US
Practice Address - Phone:402-322-2419
Practice Address - Fax:402-347-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty