Provider Demographics
NPI:1457879173
Name:BEAUGARD, JESSIE (LIMHP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:BEAUGARD
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 S 187TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3546
Mailing Address - Country:US
Mailing Address - Phone:402-689-2003
Mailing Address - Fax:
Practice Address - Street 1:5217 S 28TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3402
Practice Address - Country:US
Practice Address - Phone:402-715-5460
Practice Address - Fax:402-715-5452
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health