Provider Demographics
NPI:1205074572
Name:MELISSA D KENNEY PC
Entity type:Organization
Organization Name:MELISSA D KENNEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHP, LIMHP, CPC
Authorized Official - Phone:402-489-7827
Mailing Address - Street 1:7121 A ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4289
Mailing Address - Country:US
Mailing Address - Phone:402-489-7827
Mailing Address - Fax:402-489-7828
Practice Address - Street 1:7121 A ST STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4289
Practice Address - Country:US
Practice Address - Phone:402-489-7827
Practice Address - Fax:402-489-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025706300Medicaid