Provider Demographics
NPI:1093876872
Name:NUNNALLY, CAROL COUNTRYMAN (LCSW LIMHP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:COUNTRYMAN
Last Name:NUNNALLY
Suffix:
Gender:F
Credentials:LCSW LIMHP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:COUNTRYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LIMHP
Mailing Address - Street 1:PO BOX 57475
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505
Mailing Address - Country:US
Mailing Address - Phone:402-429-5365
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:4444 S 86TH T STE 102
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11361041C0700X
NE67101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85299OtherBCBS
NE10025273400Medicaid
NE798299000OtherMAGELLAN
NE798299000OtherMAGELLAN