MEDICARE: DR. KEENAN W KRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1130	NE
2	172V00000X	Community Health Worker
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1154675569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEENAN W KRICK

Provider Business Mailing Address
First Line	:	9802 NICHOLAS ST STE 305
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-2106
Country	:	US
Telephone Number	:
Fax Number	:	402-281-0665

Provider Business Practice Location Address
First Line	:	9802 NICHOLAS ST STE 305
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-2106
Country	:	US
Telephone Number	:	402-616-9623
Fax Number	:	402-281-0665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	05/08/2025

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