Provider Demographics
NPI:1245760479
Name:MCELMURAY DUNDEE, ANGELA REBECCA (PLMHP, PMSW, LSMW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:REBECCA
Last Name:MCELMURAY DUNDEE
Suffix:
Gender:F
Credentials:PLMHP, PMSW, LSMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071-0654
Mailing Address - Country:US
Mailing Address - Phone:402-878-2046
Mailing Address - Fax:402-878-2065
Practice Address - Street 1:AUGUSTINE DR #2
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-878-2046
Practice Address - Fax:402-878-2065
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11197101YM0800X
IA086946104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid