Provider Demographics
NPI:1992090294
Name:VICKERS, JESICA G (LPC, LIMHP, PLADC)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:G
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LPC, LIMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4880
Mailing Address - Country:US
Mailing Address - Phone:308-920-0984
Mailing Address - Fax:
Practice Address - Street 1:125 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3001
Practice Address - Country:US
Practice Address - Phone:308-234-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1114101YA0400X
NE4255101YM0800X
NE1261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)