Provider Demographics
NPI:1255486718
Name:KONRUFF, KANDY PAULINE (LMHP)
Entity Type:Individual
Prefix:
First Name:KANDY
Middle Name:PAULINE
Last Name:KONRUFF
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:KANDY
Other - Middle Name:MILLER
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103
Mailing Address - Country:US
Mailing Address - Phone:308-520-4213
Mailing Address - Fax:
Practice Address - Street 1:509 E 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6943
Practice Address - Country:US
Practice Address - Phone:308-520-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025097300Medicaid
NE10025097300Medicaid