Provider Demographics
NPI:1962607069
Name:EASON, JAY ALAN (LADC,PMSW,PMHP,ACADC)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:ALAN
Last Name:EASON
Suffix:
Gender:M
Credentials:LADC,PMSW,PMHP,ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 N 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3124
Mailing Address - Country:US
Mailing Address - Phone:402-734-5275
Mailing Address - Fax:402-734-5708
Practice Address - Street 1:2602 J ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1643
Practice Address - Country:US
Practice Address - Phone:402-734-5275
Practice Address - Fax:402-734-5708
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE619101YA0400X
IA06R112101YA0400X
NE7794101YM0800X
NE6457104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker