Provider Demographics
NPI:1952417230
Name:STUBBS, MANDY DIANE (MS, LMHP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:DIANE
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 6TH AVE
Mailing Address - Street 2:STE 45
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2386
Mailing Address - Country:US
Mailing Address - Phone:308-237-4739
Mailing Address - Fax:308-237-0367
Practice Address - Street 1:4009 6TH AVE
Practice Address - Street 2:STE 45
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2386
Practice Address - Country:US
Practice Address - Phone:308-237-4739
Practice Address - Fax:308-237-0367
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025760900Medicaid
NE10025761000Medicaid
NE47080518700Medicaid
NE47080518701Medicaid