Individual
JACOB JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 K STREET, LINCOLN, NE 68508
(402) 474-0011
Mailing address
815 K STREET, LINCOLN, NE 68508
(402) 474-0011
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1744
NE
101YM0800X
Mental Health Counselor
Primary
12068
NE
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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