Provider Demographics
NPI:1669557765
Name:SMITH TEJRAL, TORRI (IMHP)
Entity type:Individual
Prefix:
First Name:TORRI
Middle Name:
Last Name:SMITH TEJRAL
Suffix:
Gender:F
Credentials:IMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8538 S 100TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3072
Mailing Address - Country:US
Mailing Address - Phone:402-525-0674
Mailing Address - Fax:
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:402-916-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE99101YP2500X
NE1-05-2443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid