Provider Demographics
NPI:1336670140
Name:PABEN, KALEIGH (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:PABEN
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16889 OAKMONT DR APT 19
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1834
Mailing Address - Country:US
Mailing Address - Phone:402-881-5654
Mailing Address - Fax:
Practice Address - Street 1:11635 ARBOR ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5000
Practice Address - Country:US
Practice Address - Phone:402-881-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11034251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health