Individual
AGNES MELISSA IBANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC LMHP
Contact information
Practice address
8011 CHICAGO ST, OMAHA, NE 68114-3533
(402) 517-5773
(402) 551-4724
Mailing address
8011 CHICAGO ST, OMAHA, NE 68114-3533
(402) 517-5773
(402) 517-5773
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1106
NE
101YM0800X
Mental Health Counselor
Primary
2656
NE
101YP2500X
Professional Counselor
1424
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025862300
—
NE
01
—
247861
MIDLANDS CHOICE
—
01
—
84658
BLUE CROSS BLUE SHIELD
—
Enumeration date
02/13/2007
Last updated
08/30/2023
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