Provider Demographics
NPI:1780881953
Name:MANCHE, JENNIFER ANN (LCSW, LMHP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:MANCHE
Suffix:
Gender:F
Credentials:LCSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4617
Mailing Address - Country:US
Mailing Address - Phone:785-865-6952
Mailing Address - Fax:
Practice Address - Street 1:8101 O ST
Practice Address - Street 2:STE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2646
Practice Address - Country:US
Practice Address - Phone:402-261-3714
Practice Address - Fax:888-959-0716
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3586101YM0800X
NE13301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE97109OtherBCBS