Provider Demographics
NPI:1003441437
Name:COBURN, KATELYN OLIVIA (LIMHP, CMFT, LCMFT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:OLIVIA
Last Name:COBURN
Suffix:
Gender:F
Credentials:LIMHP, CMFT, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 THOMPSON CREEK BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6579
Mailing Address - Country:US
Mailing Address - Phone:785-333-3839
Mailing Address - Fax:
Practice Address - Street 1:5700 THOMPSON CREEK BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6579
Practice Address - Country:US
Practice Address - Phone:785-333-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03208101YM0800X
NE3257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health