Provider Demographics
NPI:1700770831
Name:YAKSICH, AVEREY LEE (PLMHP)
Entity type:Individual
Prefix:
First Name:AVEREY
Middle Name:LEE
Last Name:YAKSICH
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-2416
Mailing Address - Country:US
Mailing Address - Phone:402-598-7373
Mailing Address - Fax:
Practice Address - Street 1:9802 NICHOLAS ST STE 350
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2106
Practice Address - Country:US
Practice Address - Phone:402-932-2296
Practice Address - Fax:402-281-0665
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health