| Penguin Place Counseling, Llc | |
|
770 N Cotner Blvd Ste 302 Lincoln NE 68505-2342 | |
| (402) 322-2419 | |
| (402) 347-7204 |
| Full Name | Penguin Place Counseling, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 770 N Cotner Blvd Ste 302, Lincoln, Nebraska |
| Authorized Official Name and Position | Tracy Kadavy (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 4025805282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Penguin Place Counseling, Llc 770 N Cotner Blvd Ste 302 Lincoln NE 68505-2342 Ph: (402) 580-4282 | Penguin Place Counseling, Llc 770 N Cotner Blvd Ste 302 Lincoln NE 68505-2342 Ph: (402) 322-2419 |
| NPI Number | 1972196053 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 07/25/2023 |
| Certification Date | 07/25/2023 |
| Medicare PECOS PAC ID | 6800244401 |
|---|---|
| Medicare Enrollment ID | O20231120002987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972196053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tracy Lynn Mahloch Kadavy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700116134 PECOS PAC ID: 7618325218 Enrollment ID: I20231120003057 |
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