Basic Information
| Provider Information | |||||||||
| NPI: | 1972972131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | JERI | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LIMHP, CMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHELKOPF | ||||||||
| OtherFirstName: | JERI | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PLMHP, PCMSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1900 F STREET | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027593192 | ||||||||
| FaxNumber: | 4024605829 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 F STREET | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027593192 | ||||||||
| FaxNumber: | 4024605829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2015 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LIMHP1963 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | CMSW1723 | NE | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.