Provider Demographics
NPI:1265998603
Name:KATHLEEN MCGILL THERAPY, LLC
Entity type:Organization
Organization Name:KATHLEEN MCGILL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-850-6905
Mailing Address - Street 1:10059 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5520
Mailing Address - Country:US
Mailing Address - Phone:402-850-6905
Mailing Address - Fax:
Practice Address - Street 1:11605 ARBOR ST STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2982
Practice Address - Country:US
Practice Address - Phone:402-850-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)