Provider Demographics
NPI:1821412321
Name:MABUS, KYLE (LMHP, LPC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MABUS
Suffix:
Gender:M
Credentials:LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 I ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1211
Mailing Address - Country:US
Mailing Address - Phone:402-504-9056
Mailing Address - Fax:
Practice Address - Street 1:11615 I ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1211
Practice Address - Country:US
Practice Address - Phone:402-504-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4324101YM0800X
NE2104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional