Provider Demographics
NPI: | 1679781975 |
---|---|
Name: | SIEVERS, JENNY (MS, LIMHP, LADC) |
Entity Type: | Individual |
Prefix: | |
First Name: | JENNY |
Middle Name: | |
Last Name: | SIEVERS |
Suffix: | |
Gender: | F |
Credentials: | MS, LIMHP, LADC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2222 S 16TH ST |
Mailing Address - Street 2: | SUITE 420 |
Mailing Address - City: | LINCOLN |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68502-3796 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-474-2500 |
Mailing Address - Fax: | 855-805-7913 |
Practice Address - Street 1: | 2222 S 16TH ST |
Practice Address - Street 2: | SUITE 420 |
Practice Address - City: | LINCOLN |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68502-3796 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-474-2500 |
Practice Address - Fax: | 855-805-7913 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-05-18 |
Last Update Date: | 2014-03-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | P450 | 101YA0400X |
NE | 59 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NE | 59 | Other | LICENSE NUMBER |