Provider Demographics
NPI:1740681865
Name:LIDDICK, JOLYNN (PLMHP, PLADC)
Entity type:Individual
Prefix:
First Name:JOLYNN
Middle Name:
Last Name:LIDDICK
Suffix:
Gender:F
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 S 39TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-5200
Mailing Address - Country:US
Mailing Address - Phone:402-342-7007
Mailing Address - Fax:
Practice Address - Street 1:11515 S 39TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-5200
Practice Address - Country:US
Practice Address - Phone:402-342-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health