Provider Demographics
NPI:1205256500
Name:MACKEY, KIMBERLY D (MS, LIMHP, LMHP, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MS, LIMHP, LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOYS TOWN NATIONAL RESEARCH HOSPITAL RTC2
Mailing Address - Street 2:14092 HOSPITAL ROAD
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010
Mailing Address - Country:US
Mailing Address - Phone:531-355-5409
Mailing Address - Fax:531-355-5499
Practice Address - Street 1:BOYS TOWN NATIONAL RESEARCH HOSPITAL RTC2
Practice Address - Street 2:14092 HOSPITAL ROAD
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010
Practice Address - Country:US
Practice Address - Phone:531-355-5409
Practice Address - Fax:531-355-5499
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4921101Y00000X
NE2350101YP2500X
NE1714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty