Provider Demographics
NPI:1750088225
Name:JACOBY-LOFTIS, AMY ADELE (LCSW / LMHP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ADELE
Last Name:JACOBY-LOFTIS
Suffix:
Gender:F
Credentials:LCSW / LMHP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ADELE
Other - Last Name:WATTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-605-7070
Mailing Address - Fax:
Practice Address - Street 1:7215 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3574
Practice Address - Country:US
Practice Address - Phone:531-999-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5603101YM0800X
NE19871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1184332918OtherCLINIC NPI
NE1265422562OtherASSOCIATED PROVIDER NPI