Basic Information
Provider Information | |||||||||
NPI: | 1720281462 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RICH | ||||||||
FirstName: | JAMIE | ||||||||
MiddleName: | JULIA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA PLMHP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KNEIFL | ||||||||
OtherFirstName: | JAMIE | ||||||||
OtherMiddleName: | JULIA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | BA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3300 NO 60TH ST | ||||||||
Address2: |   | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 68104 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4025540520 | ||||||||
FaxNumber: | 4025518797 | ||||||||
Practice Location | |||||||||
Address1: | 3020 18TH STREET | ||||||||
Address2: | STE 17 | ||||||||
City: | COLUMBUS | ||||||||
State: | NE | ||||||||
PostalCode: | 68601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4025633833 | ||||||||
FaxNumber: | 4025628714 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2007 | ||||||||
LastUpdateDate: | 05/31/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PLMHP8306 | NE | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 1059 | NE | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.