Provider Demographics
NPI:1588006993
Name:VANDERCOY, JESSICA M (LMHP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:VANDERCOY
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 NORTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1192
Mailing Address - Country:US
Mailing Address - Phone:402-980-1261
Mailing Address - Fax:402-980-1261
Practice Address - Street 1:5605 NORTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-1192
Practice Address - Country:US
Practice Address - Phone:402-980-1261
Practice Address - Fax:402-980-1261
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1588006993Medicaid