Provider Demographics
NPI:1326030479
Name:MIRAMONTES-LANEY, CANDIDA THERESA (MS PLMHP PL ADC)
Entity type:Individual
Prefix:MS
First Name:CANDIDA
Middle Name:THERESA
Last Name:MIRAMONTES-LANEY
Suffix:
Gender:F
Credentials:MS PLMHP PL ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 THOMAS LK
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-9400
Mailing Address - Country:US
Mailing Address - Phone:402-944-2289
Mailing Address - Fax:
Practice Address - Street 1:6720 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-3211
Practice Address - Country:US
Practice Address - Phone:402-457-7782
Practice Address - Fax:402-457-7791
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7457101Y00000X
NEP-468101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)