Provider Demographics
NPI:1255527362
Name:JANTZEN, KALIKA BREKAN (LIMHP, LADC)
Entity type:Individual
Prefix:MRS
First Name:KALIKA
Middle Name:BREKAN
Last Name:JANTZEN
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 68TH STREET PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2475
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:300 S 68TH STREET PL
Practice Address - Street 2:SUITE 500
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2475
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-434-3970
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE895101YM0800X
NE713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025734000Medicaid
NE10026038300Medicaid
NE345680000OtherMAGELLAN MIS
NE47075636930Medicaid
NE47075636998Medicaid
NE10025734000Medicaid