Provider Demographics
NPI:1508858648
Name:NICOLARSEN, KATHERINE ANN (LCSW LMHP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:NICOLARSEN
Suffix:
Gender:F
Credentials:LCSW LMHP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:BURKHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP
Mailing Address - Street 1:4559 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:402-558-3857
Mailing Address - Fax:
Practice Address - Street 1:302 AMERICAN PKWY
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6270
Practice Address - Country:US
Practice Address - Phone:402-339-2544
Practice Address - Fax:402-339-4358
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2946101YM0800X
NE1177104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086011Medicare PIN