Provider Demographics
NPI:1972352490
Name:FLODINE, JAIRREN N (MSW, LMHP)
Entity type:Individual
Prefix:
First Name:JAIRREN
Middle Name:N
Last Name:FLODINE
Suffix:
Gender:F
Credentials:MSW, LMHP
Other - Prefix:
Other - First Name:JAIRREN
Other - Middle Name:N
Other - Last Name:KOEHLMOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11060 OAK ST STE 7
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4244
Mailing Address - Country:US
Mailing Address - Phone:402-204-5456
Mailing Address - Fax:
Practice Address - Street 1:11060 OAK ST STE 7
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4244
Practice Address - Country:US
Practice Address - Phone:402-204-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14291041C0700X
NE4003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical