Provider Demographics
NPI:1346220324
Name:BUSTOS, KATHY (MSW LMHP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:MSW LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PEOPLES RD
Mailing Address - Street 2:SUITE A ROOM 6
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4670
Mailing Address - Country:US
Mailing Address - Phone:402-978-5174
Mailing Address - Fax:402-341-3616
Practice Address - Street 1:2211 PEOPLES RD
Practice Address - Street 2:SUITE A ROOM 6
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4670
Practice Address - Country:US
Practice Address - Phone:402-978-5174
Practice Address - Fax:402-341-3616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0970566Medicaid
IA0970566Medicaid
NE268679Medicare ID - Type Unspecified