Provider Demographics
NPI:1568517332
Name:PRENTICE, GIANENE (LMHP)
Entity Type:Individual
Prefix:
First Name:GIANENE
Middle Name:
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SOUTH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2446
Mailing Address - Country:US
Mailing Address - Phone:402-437-8975
Mailing Address - Fax:
Practice Address - Street 1:1430 SOUTH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2446
Practice Address - Country:US
Practice Address - Phone:402-437-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055197513Medicaid