Provider Demographics
NPI:1225198831
Name:WILEY, KATHLEEN A (LMHP, LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:WILEY
Suffix:
Gender:F
Credentials:LMHP, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 W CENTER RD STE 250
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4425
Mailing Address - Country:US
Mailing Address - Phone:402-571-4984
Mailing Address - Fax:
Practice Address - Street 1:11414 W CENTER RD STE 248
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4425
Practice Address - Country:US
Practice Address - Phone:402-571-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1036101YM0800X
NE446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84583OtherBLUE CROSS BLUE SHIELD
NE47079016726Medicaid