Provider Demographics
NPI:1649493933
Name:JERICHO COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:JERICHO COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LADC, LMHP
Authorized Official - Phone:402-344-7000
Mailing Address - Street 1:1941 S 42ND ST STE 538
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2945
Mailing Address - Country:US
Mailing Address - Phone:402-344-7000
Mailing Address - Fax:402-344-8089
Practice Address - Street 1:1941 S 42ND ST STE 538
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2945
Practice Address - Country:US
Practice Address - Phone:402-344-7000
Practice Address - Fax:402-344-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE385101YA0400X
NE2166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254608-00Medicaid