Provider Demographics
NPI:1164683694
Name:LOETTERLE, JON CHRISTIAN (MSED, LMHP)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CHRISTIAN
Last Name:LOETTERLE
Suffix:
Gender:M
Credentials:MSED, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 14TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3200
Mailing Address - Country:US
Mailing Address - Phone:402-463-3640
Mailing Address - Fax:402-463-3677
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-463-3640
Practice Address - Fax:402-463-3677
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1979101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health