Basic Information
| Provider Information | |||||||||
| NPI: | 1346663077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEATHERHOLT | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | LMHP, LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DECHANT | ||||||||
| OtherFirstName: | JAIME | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 120 SOUTH 24TH STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023427007 | ||||||||
| FaxNumber: | 4026617117 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 S 24TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681021205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023427007 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2014 | ||||||||
| LastUpdateDate: | 05/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1698 | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 4959 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.