Provider Demographics
NPI:1629121546
Name:KOLLATH, JOLENE (LMSW, LMHP)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:
Last Name:KOLLATH
Suffix:
Gender:F
Credentials:LMSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DODGE ST
Mailing Address - Street 2:CHILDREN'S FAMILY SUPPORT CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:CHILDREN'S FAMILY SUPPORT CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-3900
Practice Address - Fax:402-955-3920
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE148 (CMSW)1041C0700X
NE896 (LMHP)1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84818OtherBCBS
3009OtherMIDLANDS CHOICE
6235851OtherUNITED BEHAVIORAL HEALTH