Provider Demographics
NPI:1619147014
Name:HERRELL, JOLENE (MA, LMHP, PC)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:HERRELL
Suffix:
Gender:F
Credentials:MA, LMHP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 KIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LIBORY
Mailing Address - State:NE
Mailing Address - Zip Code:68872-9783
Mailing Address - Country:US
Mailing Address - Phone:308-370-1307
Mailing Address - Fax:
Practice Address - Street 1:504 KIMBERLY WAY
Practice Address - Street 2:
Practice Address - City:SAINT LIBORY
Practice Address - State:NE
Practice Address - Zip Code:68872-9783
Practice Address - Country:US
Practice Address - Phone:308-370-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health