Provider Demographics
NPI:1952194144
Name:POLACEK, JOCELYN HELEN
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:HELEN
Last Name:POLACEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 PORT GRACE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3190
Mailing Address - Country:US
Mailing Address - Phone:406-304-6620
Mailing Address - Fax:
Practice Address - Street 1:12110 PORT GRACE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3190
Practice Address - Country:US
Practice Address - Phone:406-304-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14384101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor