Individual
JILL MARIE COLEGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHP, LPC, PLADC
Contact information
Practice address
1460 35TH AVE, COLUMBUS, NE 68601-4731
(402) 562-6767
(402) 562-6770
Mailing address
2675 E 12TH AVE, COLUMBUS, NE 68601-3713
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
685
NE
101YM0800X
Mental Health Counselor
1459
NE
101YM0800X
Mental Health Counselor
2761
NE
101YM0800X
Mental Health Counselor
Primary
550
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025329800
—
NE
01
—
244754
MIDLANDS CHOICE PPO#
NE
01
—
85470
BCBS PPO#
NE
Enumeration date
11/01/2006
Last updated
08/04/2011
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