Provider Demographics
NPI:1649811076
Name:THOMPSON, KATHRYN MCKAY (LCSW, QMHP, LIMHP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MCKAY
Last Name:THOMPSON
Suffix:
Gender:
Credentials:LCSW, QMHP, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11517 S 191ST AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-3586
Mailing Address - Country:US
Mailing Address - Phone:605-366-9800
Mailing Address - Fax:531-201-0204
Practice Address - Street 1:5814 S 142ND ST STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2855
Practice Address - Country:US
Practice Address - Phone:605-366-9800
Practice Address - Fax:531-201-0204
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2817101YM0800X
NE20731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10028008400Medicaid