MEDICARE: JESSIE A THOMPSON LIMHP, LADC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	P-1120	NE
2	101YM0800X	Mental Health Counselor	9890	NE

General Provider Information

NPI Number	:	1114266020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE A THOMPSON LIMHP, LADC, LPC

Provider Business Mailing Address
First Line	:	2301 O ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-1124
Country	:	US
Telephone Number	:	402-450-8236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 O ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-1124
Country	:	US
Telephone Number	:	402-441-7940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	11/27/2019

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