Provider Demographics
NPI:1306823422
Name:JONES, LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 ANDERMATT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6700
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:9100 ANDERMATT DRIVE SUITE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-0000
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-434-3970
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11657272OtherCAQH PROVIDER ID
NENA3283003OtherMEDICARE PTAN
NEP02109644OtherRR MEDICARE PTAN
NE10026721201Medicaid
NE276144OtherMEDICARE PTAN