Healthcare Provider Details

I. General information

NPI: 1659928331
Provider Name (Legal Business Name): JLR COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 FARNAM ST STE 301A
OMAHA NE
68131-3628
US

IV. Provider business mailing address

2377 AVENUE M WAY
COUNCIL BLUFFS IA
51501-0800
US

V. Phone/Fax

Practice location:
  • Phone: 712-355-1526
  • Fax: 844-895-1590
Mailing address:
  • Phone: 712-355-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN RATLIFF
Title or Position: OWNER
Credential: LMHC, LIMHP, CPC
Phone: 712-355-1526