Provider Demographics
NPI:1831584135
Name:JACKSON, SYBIL (LMHP, PLADC)
Entity type:Individual
Prefix:
First Name:SYBIL
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13402 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2331
Mailing Address - Country:US
Mailing Address - Phone:402-779-9438
Mailing Address - Fax:
Practice Address - Street 1:9374 N ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2307
Practice Address - Country:US
Practice Address - Phone:402-779-9438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health