Provider Demographics
NPI:1376131706
Name:POTTER, JANE (LMSW, LIMHP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMSW, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GALVIN RD N
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4898
Mailing Address - Country:US
Mailing Address - Phone:402-940-7387
Mailing Address - Fax:402-702-0538
Practice Address - Street 1:207 GALVIN RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4898
Practice Address - Country:US
Practice Address - Phone:402-940-7387
Practice Address - Fax:402-702-0538
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2149104100000X
NE3042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1028192901Medicaid
NE10028192900Medicaid