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Individual

TINA L FARDELLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMHP LCSW

Contact information

Practice address
5600 S 59TH ST STE 104, ORR PSYCHOTHERAPY RESOURCES, LINCOLN, NE 68516-2387
(402) 484-0595
(402) 484-0595
Mailing address
841 COACHMANS DRIVE, LINCOLN, NE 68510
(402) 483-5709

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2525
NE
1041C0700X
Clinical Social Worker
Primary
1058
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10024982600
NE
05
47084125026
NE
01
82697
BCBS
NE
Enumeration date
01/05/2007
Last updated
12/20/2010
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