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General NPI Number Information
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NPI Number | 1780881953
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Entity Type | Individual
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Provider Name | JENNIFER ANN MANCHE LCSW, LMHP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 05/28/2012
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Provider Practice Location Address
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Address Line | 8101 O ST STE 101
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City | LINCOLN
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State | NE
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Zip | 68510-2646
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Country | US
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Telephone | 402-261-3714
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Fax | 888-959-0716
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Provider Business Mailing Address
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Address Line | 6117 S 30TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-4617
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Country | US
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Telephone | 785-865-6952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3586
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1330
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License Number State | NE
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