Provider Demographics
NPI:1154538643
Name:GREGG, JILL C (LMHP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:GREGG
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10310 N OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-1711
Mailing Address - Country:US
Mailing Address - Phone:402-460-0514
Mailing Address - Fax:402-462-4699
Practice Address - Street 1:907 S KANSAS AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7024
Practice Address - Country:US
Practice Address - Phone:402-462-4677
Practice Address - Fax:402-462-4699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health