Provider Demographics
NPI:1871260851
Name:JUNGCK, ALEXANDRIA (PLMHP, PCMSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:JUNGCK
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 1:1430 SOUTH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2467
Mailing Address - Country:US
Mailing Address - Phone:531-500-4429
Mailing Address - Fax:402-939-0734
Practice Address - Street 1:1430 SOUTH ST STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2467
Practice Address - Country:US
Practice Address - Phone:531-500-4429
Practice Address - Fax:402-939-0734
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15186803Medicaid