Provider Demographics
NPI:1457928632
Name:KLUG, LYNETTE A (LICSW)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:A
Last Name:KLUG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 38TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1616
Mailing Address - Country:US
Mailing Address - Phone:402-564-1338
Mailing Address - Fax:402-606-4102
Practice Address - Street 1:4214 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1616
Practice Address - Country:US
Practice Address - Phone:402-564-1338
Practice Address - Fax:402-606-4102
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NE12598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health