Provider Demographics
NPI:1427547801
Name:MASSENGALE, MONICA LEE (LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LEE
Last Name:MASSENGALE
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2616 S 132ND ST
Mailing Address - Street 2:#160
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4234
Mailing Address - Country:US
Mailing Address - Phone:402-850-7322
Mailing Address - Fax:
Practice Address - Street 1:2616 S 132ND ST
Practice Address - Street 2:#160
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4234
Practice Address - Country:US
Practice Address - Phone:402-850-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11372101Y00000X
NE2804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health