Provider Demographics
NPI:1245389600
Name:KUCK JENSEN, M KATHLEEN (LMHP)
Entity Type:Individual
Prefix:
First Name:M KATHLEEN
Middle Name:
Last Name:KUCK JENSEN
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 1:222 SOUTH 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:402-345-6555
Mailing Address - Fax:402-345-0635
Practice Address - Street 1:222 SOUTH 29TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:402-345-6555
Practice Address - Fax:402-345-0635
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24445OtherMIDLANDS CHOICE
NE47 037658526Medicaid
NE85023OtherBLUE CROSS BLUE SHIELD