Provider Demographics
NPI:1992882203
Name:COLEGROVE, JILL MARIE (LMHP, LPC, PLADC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:LMHP, LPC, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1460 35TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4731
Practice Address - Country:US
Practice Address - Phone:402-562-6767
Practice Address - Fax:402-562-6770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2761101YM0800X
NE1459101YM0800X
NE685101YA0400X
NE550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025329800Medicaid
NE85470OtherBCBS PPO#
NE244754OtherMIDLANDS CHOICE PPO#