Provider Demographics
NPI:1063554053
Name:NEWLAND, CANDACE KAY (LIMHP)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:KAY
Last Name:NEWLAND
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S 174TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-3540
Mailing Address - Country:US
Mailing Address - Phone:402-991-8093
Mailing Address - Fax:402-505-9726
Practice Address - Street 1:809 S 174TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3450
Practice Address - Country:US
Practice Address - Phone:402-991-8093
Practice Address - Fax:402-505-9726
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025836700Medicaid