Provider Demographics
NPI:1669799300
Name:SEVERE, KRISTINE RUTH (LCSW LMHP)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:RUTH
Last Name:SEVERE
Suffix:
Gender:F
Credentials:LCSW LMHP
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:RUTH
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW LMHP
Mailing Address - Street 1:4539 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2509
Mailing Address - Country:US
Mailing Address - Phone:402-290-8593
Mailing Address - Fax:
Practice Address - Street 1:10846 OLD MILL RD STE 5
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2655
Practice Address - Country:US
Practice Address - Phone:402-290-8593
Practice Address - Fax:402-991-7445
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10001041C0700X
NE22251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253396-00Medicaid