Provider Demographics
NPI:1346663077
Name:WEATHERHOLT, JAIME (LMHP, LCSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:WEATHERHOLT
Suffix:
Gender:F
Credentials:LMHP, LCSW
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:DECHANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 SOUTH 24TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102
Mailing Address - Country:US
Mailing Address - Phone:402-342-7007
Mailing Address - Fax:402-661-7117
Practice Address - Street 1:120 S 24TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1205
Practice Address - Country:US
Practice Address - Phone:402-342-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16981041C0700X
NE4959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical