MEDICARE: LAURA M KINNEY LMHP

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	101YM0800X	Mental Health Counselor	9851	NE

General Provider Information

NPI Number	:	1548507767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M KINNEY LMHP

Provider Business Mailing Address
First Line	:	4254 N 139TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-5015
Country	:	US
Telephone Number	:	402-880-1683
Fax Number	:

Provider Business Practice Location Address
First Line	:	15705 W DODGE RD
Second Line	:	SUITE 102
City	:	OMAHA
State	:	NE
Zip	:	68118-2536
Country	:	US
Telephone Number	:	531-444-1963
Fax Number	:

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

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/04/2022

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