Provider Demographics
NPI:1316455447
Name:JANIS, TRINA M (LADC)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:M
Last Name:JANIS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 LANDON CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2414
Mailing Address - Country:US
Mailing Address - Phone:402-346-0902
Mailing Address - Fax:402-342-5290
Practice Address - Street 1:2240 LANDON CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2414
Practice Address - Country:US
Practice Address - Phone:402-346-0902
Practice Address - Fax:402-342-5290
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)