Provider Demographics
NPI:1184813602
Name:KATHERINE B. MERKLEY, PH.D., P.C.
Entity type:Organization
Organization Name:KATHERINE B. MERKLEY, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-934-2661
Mailing Address - Street 1:11225 DAVENPORT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2641
Mailing Address - Country:US
Mailing Address - Phone:402-934-2661
Mailing Address - Fax:402-934-2667
Practice Address - Street 1:11225 DAVENPORT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2641
Practice Address - Country:US
Practice Address - Phone:402-934-2661
Practice Address - Fax:402-934-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08234OtherBLUE CROSS BLUE SHIELD
NE100045314Medicaid
NE235376OtherMIDLANDS CHOICE
NE100045314Medicaid