Provider Demographics
NPI:1528485034
Name:EISENBARTH, KANDY (LIMHP, LMFT, LADC)
Entity type:Individual
Prefix:
First Name:KANDY
Middle Name:
Last Name:EISENBARTH
Suffix:
Gender:F
Credentials:LIMHP, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 NORMAL BLVD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5576
Mailing Address - Country:US
Mailing Address - Phone:402-327-1634
Mailing Address - Fax:402-261-8263
Practice Address - Street 1:4535 NORMAL BLVD
Practice Address - Street 2:SUITE 142
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5576
Practice Address - Country:US
Practice Address - Phone:402-327-1634
Practice Address - Fax:402-261-8263
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE492101YA0400X
NE2322101YM0800X
NE319101YM0800X
NE103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026600700Medicaid