Individual
TERESA LYNN MALLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LIMHP
Contact information
Practice address
13504 STEVENS ST, SUITE A, OMAHA, NE 68137-1634
(402) 894-9805
(402) 894-1015
Mailing address
13504 STEVENS ST, SUITE A, OMAHA, NE 68137-1634
(402) 894-9805
(402) 894-1015
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
194
NE
101YP2500X
Professional Counselor
84
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025687200
—
NE
Enumeration date
07/21/2006
Last updated
08/01/2012
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