Provider Demographics
NPI:1952619124
Name:EBERLE, JEREMY RAY (LIMHP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:RAY
Last Name:EBERLE
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 1:127 S 37TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1502
Mailing Address - Country:US
Mailing Address - Phone:402-476-2300
Mailing Address - Fax:402-476-2337
Practice Address - Street 1:630 N COTNER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2339
Practice Address - Country:US
Practice Address - Phone:402-984-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9185101Y00000X
NE1437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor