Provider Demographics
NPI:1710605423
Name:EDGECOMBE, LAUREN JO (PLMHP, PCMSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JO
Last Name:EDGECOMBE
Suffix:
Gender:F
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2286
Mailing Address - Country:US
Mailing Address - Phone:402-721-7710
Mailing Address - Fax:402-721-7712
Practice Address - Street 1:2320 N COLORADO AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2286
Practice Address - Country:US
Practice Address - Phone:402-721-7710
Practice Address - Fax:402-721-7712
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherN/A