Individual
TENGORN PHAISAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 S 24TH ST, LINCOLN, NE 68502-3056
(402) 435-2273
Mailing address
1700 S 24TH ST, LINCOLN, NE 68502-3056
(402) 435-2273
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NE
101YM0800X
Mental Health Counselor
8166
NE
Other
Enumeration date
05/21/2007
Last updated
09/27/2012
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