Provider Demographics
NPI:1073684619
Name:DOUGHERTY-KELLER, WHITNEY LEIGH (PLMHP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEIGH
Last Name:DOUGHERTY-KELLER
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3620
Mailing Address - Country:US
Mailing Address - Phone:402-341-9794
Mailing Address - Fax:
Practice Address - Street 1:6002A WENNINGHOFF RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1903
Practice Address - Country:US
Practice Address - Phone:402-980-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7697101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor