Provider Demographics
NPI:1710979851
Name:GUNDRUM, JAYNE LYNN (LMHP)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:LYNN
Last Name:GUNDRUM
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 1:16098 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-7480
Mailing Address - Country:US
Mailing Address - Phone:402-216-9506
Mailing Address - Fax:
Practice Address - Street 1:17201 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2042
Practice Address - Country:US
Practice Address - Phone:402-691-6977
Practice Address - Fax:402-445-8017
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEPLMHP 7629101YM0800X
NE3548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health