Provider Demographics
NPI:1609039262
Name:JOHN-BECKSTROM, JOLENE K (MA)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:K
Last Name:JOHN-BECKSTROM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6766 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9714
Mailing Address - Country:US
Mailing Address - Phone:402-217-0600
Mailing Address - Fax:833-815-2407
Practice Address - Street 1:5221 S 48TH ST STE 7A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2251
Practice Address - Country:US
Practice Address - Phone:402-217-0600
Practice Address - Fax:833-815-2407
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE972101YM0800X
NE8557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE456304000OtherMAGELLAN, FSI
NE96079OtherBLUE CROSS & BLUE SHIELD
NE345680000OtherMAGELLAN, FSI
NE99036OtherBLUE CROSS & BLUE SHIELD
NE47075636926Medicaid
NE47075636930Medicaid
NE47075636998Medicaid