MEDICARE: TONY L JACKSON LIMHP

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	1627	NE

General Provider Information

NPI Number	:	1235206491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY L JACKSON LIMHP

Provider Business Mailing Address
First Line	:	1309 HARLAN DR STE 102
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68005-6604
Country	:	US
Telephone Number	:	402-690-1880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 HARLAN DR STE 102
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68005-6604
Country	:	US
Telephone Number	:	402-690-1880
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/24/2025

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