Provider Demographics
NPI:1396811899
Name:WAIS KLEIN, THERESA L (LMHP, LCSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:WAIS KLEIN
Suffix:
Gender:F
Credentials:LMHP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 S 138TH ST
Mailing Address - Street 2:STE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2946
Mailing Address - Country:US
Mailing Address - Phone:402-819-9748
Mailing Address - Fax:
Practice Address - Street 1:5332 S 138TH ST
Practice Address - Street 2:STE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2946
Practice Address - Country:US
Practice Address - Phone:402-819-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278406Medicare ID - Type UnspecifiedMEDICARE PART B