Healthcare Provider Details

I. General information

NPI: 1235052580
Provider Name (Legal Business Name): JAELYN LAURA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 O ST STE 5
LINCOLN NE
68510-1532
US

IV. Provider business mailing address

1125 Q ST APT 1801
LINCOLN NE
68508-1575
US

V. Phone/Fax

Practice location:
  • Phone: 140-226-1504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14966
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: