Provider Demographics
NPI:1881858132
Name:MCMAHON, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34367
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0367
Mailing Address - Country:US
Mailing Address - Phone:402-393-0163
Mailing Address - Fax:402-393-7187
Practice Address - Street 1:2211 PEOPLES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4670
Practice Address - Country:US
Practice Address - Phone:402-682-9694
Practice Address - Fax:402-682-9678
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1167101YM0800X
NE7091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE111324000Medicaid