Basic Information
| Provider Information | |||||||||
| NPI: | 1679937486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAW | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | CRAW | ||||||||
| OtherFirstName: | AMANDA | ||||||||
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| OtherCredential: | PLMHP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 124 S 24TH ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681021226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022929105 | ||||||||
| FaxNumber: | 4025915075 | ||||||||
| Practice Location | |||||||||
| Address1: | 11515 S 39TH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681235200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022929105 | ||||||||
| FaxNumber: | 4025915075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.