Provider Demographics
NPI:1891062527
Name:STICKMAN, JAYNE (MS, LMHP)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:STICKMAN
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 GRANT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3475
Mailing Address - Country:US
Mailing Address - Phone:402-707-9695
Mailing Address - Fax:402-504-4584
Practice Address - Street 1:11919 GRANT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3475
Practice Address - Country:US
Practice Address - Phone:402-707-9695
Practice Address - Fax:402-504-4584
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2022101YP2500X
NE4116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional