Provider Demographics
NPI:1164860102
Name:WOCKENFUSS, KYLE (LMHP, CPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:WOCKENFUSS
Suffix:
Gender:M
Credentials:LMHP, CPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19839 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2593
Mailing Address - Country:US
Mailing Address - Phone:402-418-1540
Mailing Address - Fax:
Practice Address - Street 1:5930 S 58TH ST STE J
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3653
Practice Address - Country:US
Practice Address - Phone:402-623-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9988101YM0800X
NE5154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health