Provider Demographics
NPI:1497598734
Name:KAHN, LYDIA (TMHC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:KAHN
Suffix:
Gender:F
Credentials:TMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10826 OLD MILL RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2660
Mailing Address - Country:US
Mailing Address - Phone:402-651-5095
Mailing Address - Fax:
Practice Address - Street 1:29 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9070
Practice Address - Country:US
Practice Address - Phone:904-502-4261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health