Provider Demographics
NPI:1821628470
Name:GUMB, AMY ELAINE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELAINE
Last Name:GUMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 PRAIRIE VIEW PL
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8300
Mailing Address - Country:US
Mailing Address - Phone:800-423-1342
Mailing Address - Fax:308-865-2931
Practice Address - Street 1:1755 PRAIRIE VIEW PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8300
Practice Address - Country:US
Practice Address - Phone:083-865-2249
Practice Address - Fax:308-865-2931
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health