Healthcare Provider Details

I. General information

NPI: 1114266020
Provider Name (Legal Business Name): JESSIE A THOMPSON LIMHP, LADC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 O ST
LINCOLN NE
68510-1124
US

IV. Provider business mailing address

2301 O ST
LINCOLN NE
68510-1124
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-7940
  • Fax:
Mailing address:
  • Phone: 402-450-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-1120
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9890
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: