1376664516 NPI number — J.P. LEE, LLC

Table of content: (NPI 1376664516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376664516 NPI number — J.P. LEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.P. LEE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376664516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 N OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69101-3764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-532-8300
Provider Business Mailing Address Fax Number:
308-532-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 N OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-532-8300
Provider Business Practice Location Address Fax Number:
308-532-4329
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
JERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER THERAPIST
Authorized Official Telephone Number:
308-532-8300

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  398 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YA0400X , with the licence number: P-521 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: 1411 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6023 . This is a "MIDLANDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85743 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 068988 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 85516 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025349500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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