Healthcare Provider Details

I. General information

NPI: 1033014261
Provider Name (Legal Business Name): JAYDEN AUSTIN MATTHEW HAGOOD D.DIV, THM, STL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 S 31ST ST
LINCOLN NE
68516-4673
US

IV. Provider business mailing address

6510 S 31ST ST
LINCOLN NE
68516-4673
US

V. Phone/Fax

Practice location:
  • Phone: 402-480-9835
  • Fax:
Mailing address:
  • Phone: 402-480-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: