Individual
JENA UPHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4545 S 86TH ST, LINCOLN, NE 68526-9262
(402) 483-6990
Mailing address
4545 S 86TH ST, LINCOLN, NE 68526-9262
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
12634
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2018
Last updated
07/01/2021
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