Healthcare Provider Details

I. General information

NPI: 1790597383
Provider Name (Legal Business Name): JESSE GLACKIN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 21ST ST STE 400A
LINCOLN NE
68510-1044
US

IV. Provider business mailing address

200 S 21ST ST STE 400A
LINCOLN NE
68510-1044
US

V. Phone/Fax

Practice location:
  • Phone: 712-346-8213
  • Fax:
Mailing address:
  • Phone: 712-346-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSE THOMAS JUNG GLACKIN
Title or Position: THERAPIST/OWNER
Credential: LHMP
Phone: 712-346-8213