Provider Demographics
NPI:1851537302
Name:BLANCO, MAGDA MARIA (LMHC, LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:MAGDA
Middle Name:MARIA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:LMHC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 SOUTH 42ND ST SUITE 541
Mailing Address - Street 2:SUITE 541
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105
Mailing Address - Country:US
Mailing Address - Phone:402-934-4618
Mailing Address - Fax:402-934-4628
Practice Address - Street 1:1941 SOUTH 42ND ST SUITE 541
Practice Address - Street 2:SUITE 541
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-934-4618
Practice Address - Fax:402-934-4628
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7719101YM0800X
NE869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health