Provider Demographics
NPI:1801514765
Name:EBERLY, JAMIE DAWN (LMHP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DAWN
Last Name:EBERLY
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2694
Mailing Address - Country:US
Mailing Address - Phone:402-740-5037
Mailing Address - Fax:
Practice Address - Street 1:1203 W 33RD ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2694
Practice Address - Country:US
Practice Address - Phone:402-740-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3285101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor