Provider Demographics
NPI:1073649489
Name:FOURNIER, JUTTA L (LMHP)
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:L
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11836 ARBOR ST
Mailing Address - Street 2:VISINET INC
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-898-8881
Mailing Address - Fax:402-898-8886
Practice Address - Street 1:11836 ARBOR ST
Practice Address - Street 2:VISINET INC
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144
Practice Address - Country:US
Practice Address - Phone:402-898-8881
Practice Address - Fax:402-898-8886
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3082 LMHP101YM0800X
NE1607 CPC101YM0800X
NE90201 NCC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health