Provider Demographics
NPI:1104255819
Name:NEWTON, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9412 GILES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3064
Mailing Address - Country:US
Mailing Address - Phone:402-916-4539
Mailing Address - Fax:402-403-5857
Practice Address - Street 1:945 N ADAMS ST STE 7
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3111
Practice Address - Country:US
Practice Address - Phone:402-680-3088
Practice Address - Fax:402-403-5857
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst