Healthcare Provider Details

I. General information

NPI: 1184799512
Provider Name (Legal Business Name): JILL M SKINNER LIMHP, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL M PETERS

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WEST 1ST
OGALLALA NE
69153-2412
US

IV. Provider business mailing address

110 N BAILEY AVE P.O. BOX 1209
NORTH PLATTE NE
69101-1209
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-3084
  • Fax: 308-284-6513
Mailing address:
  • Phone: 308-284-6519
  • Fax: 308-284-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1526
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number959
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number124
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: