Provider Demographics
NPI:1306997986
Name:METSCHKE, JONATHAN CARL (MA-LMHP)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CARL
Last Name:METSCHKE
Suffix:
Gender:M
Credentials:MA-LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 LITTLE SALT RD
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-7803
Mailing Address - Country:US
Mailing Address - Phone:402-646-2240
Mailing Address - Fax:402-646-2240
Practice Address - Street 1:510 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1708
Practice Address - Country:US
Practice Address - Phone:402-643-0535
Practice Address - Fax:402-643-0540
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3522101YM0800X
NE1769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
82199OtherBLUE CROSS AND BLUE SHIELD
NE47084125026Medicaid