Provider Demographics
NPI:1871055129
Name:LATOSHA JACKSON
Entity type:Organization
Organization Name:LATOSHA JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICIAN SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, CMSW
Authorized Official - Phone:402-469-6899
Mailing Address - Street 1:5539 S 27TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1600
Mailing Address - Country:US
Mailing Address - Phone:402-261-8313
Mailing Address - Fax:
Practice Address - Street 1:5539 S 27TH ST STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1600
Practice Address - Country:US
Practice Address - Phone:402-261-8313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)