Provider Demographics
NPI:1225486004
Name:VANDERPOOL, AMY (LIMHP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3210
Mailing Address - Country:US
Mailing Address - Phone:402-203-0880
Mailing Address - Fax:402-933-9998
Practice Address - Street 1:1145 HIGH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4440
Practice Address - Country:US
Practice Address - Phone:402-423-6464
Practice Address - Fax:402-423-6465
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health