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General NPI Number Information
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NPI Number | 1750567202
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Entity Type | Individual
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Provider Name | ANDREW JERUSIK
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Gender | Male
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 10100 CEDAR ISLAND RD
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City | BELLEVUE
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State | NE
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Zip | 68123-5048
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Country | US
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Telephone | 720-236-9624
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Fax |
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Provider Business Mailing Address
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Address Line | 6618 MICHAEL CIR
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City | PAPILLION
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State | NE
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Zip | 68133-3239
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Country | US
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Telephone | 720-236-9624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3794
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4150
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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