Provider Demographics
NPI:1255878195
Name:NIENABER, AMMY (LPCC)
Entity type:Individual
Prefix:
First Name:AMMY
Middle Name:
Last Name:NIENABER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W ELMWOOD DR STE 213
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4263
Mailing Address - Country:US
Mailing Address - Phone:937-234-7830
Mailing Address - Fax:937-723-8498
Practice Address - Street 1:77 W ELMWOOD DR STE 213
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4263
Practice Address - Country:US
Practice Address - Phone:937-234-7830
Practice Address - Fax:937-723-8498
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500867101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH130910OtherMEDICARE GROUP PTAN
OH01-0693OtherCARF CERTIFICATION
OH0074861OtherMEDICAID-ODADAS
OH0074946OtherMEDICAID-ODMH