Provider Demographics
NPI:1164658464
Name:MUNDIL, KIMBERLEY K (LMHP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:K
Last Name:MUNDIL
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ELBA AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-2042
Mailing Address - Country:US
Mailing Address - Phone:402-476-9765
Mailing Address - Fax:
Practice Address - Street 1:2201 S 17TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3713
Practice Address - Country:US
Practice Address - Phone:402-441-8928
Practice Address - Fax:402-441-8399
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health