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General NPI Number Information
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NPI Number | 1114732971
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Entity Type | Organization
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Legal Business Name | KEVIN BERRYMAN, LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 11905 ARBOR ST
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City | OMAHA
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State | NE
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Zip | 68144-2970
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Country | US
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Telephone | 402-330-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 5821 CHARLES ST
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City | OMAHA
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State | NE
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Zip | 68132-1320
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Country | US
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Telephone | 402-515-2266
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. KEVIN BENTON BERRYMAN
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Credential | PHD
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Telephone | 402-515-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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