Provider Demographics
NPI:1053018697
Name:WHITEHEAD, JONATHAN FREDERICK
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:FREDERICK
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 K ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2960
Mailing Address - Country:US
Mailing Address - Phone:402-474-0011
Mailing Address - Fax:
Practice Address - Street 1:4600 VALLEY RD STE 350
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4844
Practice Address - Country:US
Practice Address - Phone:402-474-0011
Practice Address - Fax:402-474-0012
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker