Provider Demographics
NPI:1447092895
Name:LONGMORE, AMANDA (PLCSW PLMHP PCDGC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LONGMORE
Suffix:
Gender:F
Credentials:PLCSW PLMHP PCDGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4466
Mailing Address - Country:US
Mailing Address - Phone:308-636-6284
Mailing Address - Fax:
Practice Address - Street 1:122 N ALLEN AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4466
Practice Address - Country:US
Practice Address - Phone:308-636-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13855101YM0800X
NE80151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health