Provider Demographics
NPI:1316390537
Name:LEUENBERGER, MARILYN MARIE (LMHP, LADC, MED AIDE)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:LEUENBERGER
Suffix:
Gender:F
Credentials:LMHP, LADC, MED AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 J ST
Mailing Address - Street 2:100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2900
Mailing Address - Country:US
Mailing Address - Phone:402-435-4044
Mailing Address - Fax:402-435-4051
Practice Address - Street 1:650 J ST
Practice Address - Street 2:100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2900
Practice Address - Country:US
Practice Address - Phone:402-435-4044
Practice Address - Fax:402-435-4051
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE127101YA0400X
NE2064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)