Provider Demographics
NPI:1699398883
Name:THOMPSON, KAYLA (PLMHP, MSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PLMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3058 S 60TH ST APT 37
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-4338
Mailing Address - Country:US
Mailing Address - Phone:651-323-8513
Mailing Address - Fax:
Practice Address - Street 1:4545 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3251
Practice Address - Country:US
Practice Address - Phone:402-553-6000
Practice Address - Fax:402-553-2428
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPENDINGMedicaid