Provider Demographics
NPI:1104484518
Name:JINES, ALEX LYNN (LADC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:LYNN
Last Name:JINES
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:LYNN
Other - Last Name:AKERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC
Mailing Address - Street 1:419 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2127
Mailing Address - Country:US
Mailing Address - Phone:308-762-7177
Mailing Address - Fax:
Practice Address - Street 1:419 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2127
Practice Address - Country:US
Practice Address - Phone:308-762-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1435101YA0400X
NE1334101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP-1435Medicaid
1104484518OtherNPI