Provider Demographics
NPI:1407990138
Name:HAAKENSTAD, KIKI T (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:KIKI
Middle Name:T
Last Name:HAAKENSTAD
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:MRS
Other - First Name:KIKI
Other - Middle Name:T
Other - Last Name:HAAKENSTAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHP
Mailing Address - Street 1:300 S 68TH STREET PL STE 500
Mailing Address - Street 2:FIRST STEP RECOVERY CENTER INC.
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2475
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:300 S 68TH STREET PL STE 500
Practice Address - Street 2:FIRST STEP RECOVERY CENTER INC.
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2475
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-434-3970
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026038300Medicaid
NE47075636930OtherTIN FIRST STEP
NE47075636998Medicaid
NE47075636998Medicaid