Provider Demographics
NPI:1740604685
Name:FEGENBUSH, ADRIANA (LMHC)
Entity type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:
Last Name:FEGENBUSH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:ADRIANA
Other - Middle Name:PATRICIA
Other - Last Name:AGUDELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:9011 BURT ST
Mailing Address - Street 2:APT 108
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2477
Mailing Address - Country:US
Mailing Address - Phone:712-899-0242
Mailing Address - Fax:
Practice Address - Street 1:500 WILLOW AVE
Practice Address - Street 2:SUITE209
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0827
Practice Address - Country:US
Practice Address - Phone:712-352-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health