Provider Demographics
NPI:1770195018
Name:VEGA, JOLIE (PLMHP)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:JOLIE
Other - Middle Name:
Other - Last Name:FARLEY-WAMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8101 O ST # S300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2646
Mailing Address - Country:US
Mailing Address - Phone:402-261-3714
Mailing Address - Fax:
Practice Address - Street 1:8101 O ST # S300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2646
Practice Address - Country:US
Practice Address - Phone:402-261-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health