Provider Demographics
NPI:1891735635
Name:SPENCE, ALICE ANN (MS LMHC LMHP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANN
Last Name:SPENCE
Suffix:
Gender:F
Credentials:MS LMHC LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W BROADWAY
Mailing Address - Street 2:STE 270
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503
Mailing Address - Country:US
Mailing Address - Phone:712-256-7511
Mailing Address - Fax:712-256-9766
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:STE 270
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503
Practice Address - Country:US
Practice Address - Phone:712-256-7511
Practice Address - Fax:712-256-9766
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE2793101YP2500X
IAIA00873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
I3639Medicare ID - Type Unspecified