Provider Demographics
NPI:1659113561
Name:KINGSLEY, TRICIA (CPSS)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 ORCHARD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1807
Mailing Address - Country:US
Mailing Address - Phone:402-520-6616
Mailing Address - Fax:402-520-6610
Practice Address - Street 1:5350 COOPER AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5022
Practice Address - Country:US
Practice Address - Phone:402-520-6616
Practice Address - Fax:402-520-6610
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
NECPSS-179175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator