Provider Demographics
NPI:1457493439
Name:IBANEZ, AGNES MELISSA (LPC LMHP)
Entity Type:Individual
Prefix:
First Name:AGNES MELISSA
Middle Name:
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:LPC LMHP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:IBANEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8011 CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3533
Mailing Address - Country:US
Mailing Address - Phone:402-517-5773
Mailing Address - Fax:402-517-5773
Practice Address - Street 1:8011 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3533
Practice Address - Country:US
Practice Address - Phone:402-517-5773
Practice Address - Fax:402-551-4724
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1106101YM0800X
NE1424101YP2500X
NE2656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
247861OtherMIDLANDS CHOICE
NE10025862300Medicaid
84658OtherBLUE CROSS BLUE SHIELD