Healthcare Provider Details

I. General information

NPI: 1639622061
Provider Name (Legal Business Name): KELLY K ESPENSCHADE LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 12/31/2022
Certification Date: 12/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 GLYNOAKS DR STE 180
LINCOLN NE
68516-6378
US

IV. Provider business mailing address

8333 GLYNOAKS DR STE 180
LINCOLN NE
68516-6378
US

V. Phone/Fax

Practice location:
  • Phone: 402-817-2116
  • Fax:
Mailing address:
  • Phone: 402-817-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2903
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4808
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: