Provider Demographics
NPI:1710049325
Name:CUNNINGHAM, CAROL SUE (MS LMHP CPC CMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS LMHP CPC CMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 NORMAL BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5250
Mailing Address - Country:US
Mailing Address - Phone:402-434-2550
Mailing Address - Fax:402-434-2358
Practice Address - Street 1:3901 NORMAL BLVD
Practice Address - Street 2:STE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5250
Practice Address - Country:US
Practice Address - Phone:402-434-2550
Practice Address - Fax:402-434-2358
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1095101YM0800X
NE883101YP2500X
NE029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84436OtherBCBS
NE294496000OtherMIS NUMBER MAGELLAN
NE47067928413Medicaid
NE294496000OtherMIS NUMBER MAGELLAN