Healthcare Provider Details

I. General information

NPI: 1942865399
Provider Name (Legal Business Name): JENNIFER MICHELLE ROKEBY-MAYEUX CMSW, LMHP, PLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 NORTH 38TH STREET
LINCOLN NE
68504
US

IV. Provider business mailing address

PO BOX 4233
LINCOLN NE
68504-0233
US

V. Phone/Fax

Practice location:
  • Phone: 402-405-4815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-1462
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5164
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1776
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: