Provider Demographics
NPI:1568526788
Name:PATIL, JAY DOMINIC (MS, LMHP, NCC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:DOMINIC
Last Name:PATIL
Suffix:
Gender:M
Credentials:MS, LMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N 50TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2245
Mailing Address - Country:US
Mailing Address - Phone:402-321-5805
Mailing Address - Fax:
Practice Address - Street 1:13460 WALSH DR
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7529
Practice Address - Country:US
Practice Address - Phone:402-498-3358
Practice Address - Fax:402-498-3375
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025745300Medicaid
NE47037660631Medicaid
NE10026139700Medicaid