Provider Demographics
NPI:1679797906
Name:GEARHART, JEANETTE RAE (LMHP CSW)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:RAE
Last Name:GEARHART
Suffix:
Gender:F
Credentials:LMHP CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 14TH ST
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4854
Mailing Address - Country:US
Mailing Address - Phone:402-562-7933
Mailing Address - Fax:402-562-7022
Practice Address - Street 1:2919 15TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4809
Practice Address - Country:US
Practice Address - Phone:402-563-2466
Practice Address - Fax:402-563-2427
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2355101YM0800X
NE934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076510703Medicaid