Basic Information
| Provider Information | |||||||||
| NPI: | 1558832543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REITZ | ||||||||
| FirstName: | JILLIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 S 24TH ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681021226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029785644 | ||||||||
| FaxNumber: | 4025915075 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 O ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685101124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024417940 | ||||||||
| FaxNumber: | 4024418625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2018 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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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 | 101YM0800X | 11439 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.