Provider Demographics
NPI:1649508722
Name:JAKSHA, JAMES A
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:JAKSHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 N C ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-3401
Mailing Address - Country:US
Mailing Address - Phone:402-721-4180
Mailing Address - Fax:
Practice Address - Street 1:1731 N C ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3401
Practice Address - Country:US
Practice Address - Phone:402-721-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4190101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor