Provider Demographics
NPI:1588916829
Name:STOKEBRAND, TERA LANE (PLMHP)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:LANE
Last Name:STOKEBRAND
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-1218
Mailing Address - Country:US
Mailing Address - Phone:402-230-9130
Mailing Address - Fax:402-759-3803
Practice Address - Street 1:942 N 13TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-1218
Practice Address - Country:US
Practice Address - Phone:402-230-9130
Practice Address - Fax:402-759-3803
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health