Provider Demographics
NPI:1720334659
Name:BIEBER, KRISTIN ELLEN (PHD, LP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELLEN
Last Name:BIEBER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ELLEN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13460 WALSH DR
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7529
Mailing Address - Country:US
Mailing Address - Phone:402-498-3358
Mailing Address - Fax:402-498-3375
Practice Address - Street 1:13460 WALSH DR
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7529
Practice Address - Country:US
Practice Address - Phone:402-498-3358
Practice Address - Fax:402-498-3375
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4335101Y00000X
NE862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470376606-31Medicaid
NE47037660639Medicaid
NE470376606-31Medicaid
NE47037660639Medicaid