Provider Demographics
NPI:1417268178
Name:VANLANINGHAM, AMANDA L (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:VANLANINGHAM
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:NE
Mailing Address - Zip Code:68372-1423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 IVY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2301
Practice Address - Country:US
Practice Address - Phone:402-826-2000
Practice Address - Fax:402-826-2655
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4087101YM0800X
NE997101YA0400X
NE1085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025207700Medicaid
NE10025208200Medicaid
NE47052851505Medicaid
NE10025207900Medicaid
NE47052851508Medicaid
NE47052851510Medicaid