Healthcare Provider Details

I. General information

NPI: 1649469818
Provider Name (Legal Business Name): KRISTINE ROBINSON PRATT MS, LIMHP, CMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N 191ST AVE
ELKHORN NE
68022-3350
US

IV. Provider business mailing address

3401 N 191ST AVE
ELKHORN NE
68022-3350
US

V. Phone/Fax

Practice location:
  • Phone: 402-915-8900
  • Fax: 402-979-9897
Mailing address:
  • Phone: 402-915-8900
  • Fax: 402-979-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4590
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: