Provider Demographics
NPI:1902073703
Name:MOLINE, JAMIE (MA LMHP CPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOLINE
Suffix:
Gender:F
Credentials:MA LMHP CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 S 29TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5841
Mailing Address - Country:US
Mailing Address - Phone:402-204-0341
Mailing Address - Fax:
Practice Address - Street 1:7130 S 29TH ST STE G
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5841
Practice Address - Country:US
Practice Address - Phone:402-204-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96065OtherBCBS
NE$$$$$$$$$Medicaid