Provider Demographics
NPI:1194860593
Name:BERRYMAN, KEVIN (LMHP AND PA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:BERRYMAN
Suffix:
Gender:M
Credentials:LMHP AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 328
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2943
Mailing Address - Country:US
Mailing Address - Phone:402-614-8444
Mailing Address - Fax:402-614-8443
Practice Address - Street 1:1941 S 42ND ST STE 328
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2943
Practice Address - Country:US
Practice Address - Phone:402-614-8444
Practice Address - Fax:402-614-8443
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3306101Y00000X
NE1068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE20025660400Medicaid
NE47037660626Medicaid
NE47037660631Medicaid