Provider Demographics
NPI:1972644961
Name:K.R.L. PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:K.R.L. PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-486-3011
Mailing Address - Street 1:15101 BENNET RD
Mailing Address - Street 2:
Mailing Address - City:BENNET
Mailing Address - State:NE
Mailing Address - Zip Code:68317-2014
Mailing Address - Country:US
Mailing Address - Phone:402-473-2824
Mailing Address - Fax:402-782-2283
Practice Address - Street 1:15101 BENNET RD
Practice Address - Street 2:
Practice Address - City:BENNET
Practice Address - State:NE
Practice Address - Zip Code:68317-2014
Practice Address - Country:US
Practice Address - Phone:402-473-2824
Practice Address - Fax:402-782-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08108OtherBLUE CROSS BLUE SHIELD
NE08108OtherBLUE CROSS BLUE SHIELD