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General NPI Number Information
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NPI Number | 1619211778
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Entity Type | Organization
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Legal Business Name | NANCY CUNNINGHAM
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 230 E 22ND ST SUITE 3
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City | FREMONT
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State | NE
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Zip | 68025-2661
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Country | US
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Telephone | 402-721-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E 22ND ST SUITE 3
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City | FREMONT
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State | NE
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Zip | 68025-2661
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Country | US
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Telephone | 402-721-8805
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | NANCY CUNNINGHAM
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Credential | LMHP
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Telephone | 402-721-8805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3955
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License Number State | NE
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