Provider Demographics
NPI:1457421984
Name:CANELL, JANE (LIMHP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:CANELL
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 3RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3918
Mailing Address - Country:US
Mailing Address - Phone:308-534-7170
Mailing Address - Fax:308-534-2377
Practice Address - Street 1:102 E 3RD ST STE 103
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3918
Practice Address - Country:US
Practice Address - Phone:308-534-7170
Practice Address - Fax:308-534-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE820101YM0800X
NE265106H00000X
NE953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEA084931OtherVALUE OPTIONS
NE85052OtherBLUE CROSS/BLUE SHIELD
NE2113921OtherCIGNA BEHAVIORAL HEALTH
NE47058702169101A004OtherTRIWEST