Provider Demographics
NPI:1154675569
Name:KRICK, KEENAN W
Entity type:Individual
Prefix:DR
First Name:KEENAN
Middle Name:W
Last Name:KRICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 NICHOLAS ST STE 305
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:402-281-0665
Practice Address - Street 1:9802 NICHOLAS ST STE 305
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2106
Practice Address - Country:US
Practice Address - Phone:402-616-9623
Practice Address - Fax:402-281-0665
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1130101YA0400X
172V00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker