MEDICARE: JACOB GLEASON

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	13873	NE

General Provider Information

NPI Number	:	1174191746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB GLEASON

Provider Business Mailing Address
First Line	:	256 N 115TH ST STE 3
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2558
Country	:	US
Telephone Number	:	402-949-0577
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 N 115TH ST STE 3
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2558
Country	:	US
Telephone Number	:	402-949-0577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2021
Last Update Date	:	02/17/2026

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Directions to “ JACOB GLEASON ” Practice Location

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