Provider Demographics
NPI:1932237336
Name:MOORE, KATHLEEN P (LADC PLMHP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:P
Last Name:MOORE
Suffix:
Gender:F
Credentials:LADC PLMHP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC PLMHP
Mailing Address - Street 1:10018 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2460
Mailing Address - Country:US
Mailing Address - Phone:402-292-1208
Mailing Address - Fax:402-292-2110
Practice Address - Street 1:2009 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5055
Practice Address - Country:US
Practice Address - Phone:402-292-7335
Practice Address - Fax:402-292-2110
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE84101YA0400X
NE7143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health