Provider Demographics
NPI:1811640097
Name:CUNNINGHAM, JACOB JOHN CONNOR (LIMHP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JOHN CONNOR
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N 129TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-6116
Mailing Address - Country:US
Mailing Address - Phone:402-980-6285
Mailing Address - Fax:
Practice Address - Street 1:706 N 129TH ST STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-6116
Practice Address - Country:US
Practice Address - Phone:402-980-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3522101Y00000X, 101YM0800X
NE12875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor