Provider Demographics
NPI:1720445208
Name:LUCK, JONNAE (LIMHP, LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:JONNAE
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:LIMHP, LCSW, LADC
Other - Prefix:
Other - First Name:JONNAE
Other - Middle Name:
Other - Last Name:REAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3402
Mailing Address - Country:US
Mailing Address - Phone:402-554-0520
Mailing Address - Fax:402-551-8797
Practice Address - Street 1:4911 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2380
Practice Address - Country:US
Practice Address - Phone:562-746-5150
Practice Address - Fax:402-551-8797
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10719101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037661200Medicaid
NE10025225100Medicaid