Individual
AMMY NIENABER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
77 W ELMWOOD DR STE 213, CENTERVILLE, OH 45459-4263
(937) 234-7830
(937) 723-8498
Mailing address
77 W ELMWOOD DR STE 213, CENTERVILLE, OH 45459-4263
(937) 234-7830
(937) 723-8498
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.1500867
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID-ODADAS
OH
01
—
0074946
MEDICAID-ODMH
OH
01
—
01-0693
CARF CERTIFICATION
OH
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
01/30/2017
Last updated
01/17/2024
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