Provider Demographics
NPI:1104047240
Name:JONES, LETROY (PLMHP)
Entity type:Individual
Prefix:
First Name:LETROY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 E SHORE DR
Mailing Address - Street 2:BERNIKLAW EDUCATION SOLUTIONS TEAM
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3943
Mailing Address - Country:US
Mailing Address - Phone:402-420-2888
Mailing Address - Fax:402-420-2942
Practice Address - Street 1:11401 S 70TH ST
Practice Address - Street 2:BERNIKLAW EDUCATION SOLUTIONS TEAM
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-9218
Practice Address - Country:US
Practice Address - Phone:402-420-2888
Practice Address - Fax:402-420-2942
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6922101YA0400X
NEP193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health