Provider Demographics
NPI:1033186507
Name:LUDLOW, LEANNA (MA LIMFT LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:F
Credentials:MA LIMFT LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N 191ST AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3350
Mailing Address - Country:US
Mailing Address - Phone:402-915-8900
Mailing Address - Fax:402-915-8946
Practice Address - Street 1:3401 N 191ST AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3350
Practice Address - Country:US
Practice Address - Phone:402-915-8900
Practice Address - Fax:402-915-8946
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMFT111106H00000X
NELMHP2796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85447OtherBCBS
NE47083207826Medicaid