Provider Demographics
NPI:1558372839
Name:PISKE, KEVIN RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAY
Last Name:PISKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3542
Mailing Address - Country:US
Mailing Address - Phone:402-991-0611
Mailing Address - Fax:402-991-6228
Practice Address - Street 1:805 NEW HAMPSHIRE ST STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2774
Practice Address - Country:US
Practice Address - Phone:785-214-4012
Practice Address - Fax:785-212-4015
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2587103TC0700X
NE306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08484OtherBC/BS
NE9185OtherMIDLANDS CHOICE
NE4708316S926Medicaid
NE08015OtherBCBS OF NE
NE47080527026Medicaid
NE9185OtherMIDLANDS CHOICE
NE08484OtherBC/BS