Provider Demographics
NPI:1093136301
Name:KERR, TODD RAY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:RAY
Last Name:KERR
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 BURT ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1598
Mailing Address - Country:US
Mailing Address - Phone:402-965-4004
Mailing Address - Fax:402-965-4232
Practice Address - Street 1:11920 BURT ST
Practice Address - Street 2:SUITE 190
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1598
Practice Address - Country:US
Practice Address - Phone:402-965-4004
Practice Address - Fax:402-965-4232
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4118101YM0800X
NE2023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health