MEDICARE: JCB THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1115	NE

General Provider Information

NPI Number	:	1144767245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCB THERAPY LLC

Provider Business Mailing Address
First Line	:	11605 W DODGE RD STE 4
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2566
Country	:	US
Telephone Number	:	402-881-6050
Fax Number	:	531-999-2356

Provider Business Practice Location Address
First Line	:	11605 W DODGE RD STE 4
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2566
Country	:	US
Telephone Number	:	402-881-6050
Fax Number	:	531-999-2356

Authorized Official
Title or Position	:	OWNER
Name	:	JAYNA BACZWASKI
Credential	:
Telephone Number	:	402-881-6050

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	11/20/2019

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Directions to “JCB THERAPY LLC ” Practice Location

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