Provider Demographics
NPI:1235612722
Name:DOTZLER, JASON (PLMHP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DOTZLER
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20275 HONEYSUCKLE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3962
Mailing Address - Country:US
Mailing Address - Phone:402-933-5700
Mailing Address - Fax:402-933-9998
Practice Address - Street 1:8922 CUMING ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2732
Practice Address - Country:US
Practice Address - Phone:402-926-4373
Practice Address - Fax:402-926-3898
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid