Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 610 | NE |
NPI | 1003572249 |
---|---|
Provider Name | Dr. Thomas Robert Cardwell |
First Address | Lincoln, NE 68502-3704 |
Second Address | Lincoln, NE 68502-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2021 |
Last Update Date | 11/11/2021 |