Provider Demographics
NPI:1194926188
Name:PHILLIPS, JERRI LEE (LMHP)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:LEE
Last Name:PHILLIPS
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 1:21475 NEBRASKA 10
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68866
Mailing Address - Country:US
Mailing Address - Phone:308-530-8166
Mailing Address - Fax:
Practice Address - Street 1:21475 NEBRASKA 10
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:NE
Practice Address - Zip Code:68866
Practice Address - Country:US
Practice Address - Phone:308-530-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101YA0400X
NE1411, 943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85516OtherBLUECROSSBLUESHIELD
NE600025320Medicaid
NE6023OtherMIDLANDS