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General NPI Number Information
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NPI Number | 1164860102
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Entity Type | Individual
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Provider Name | KYLE WOCKENFUSS LMHP, CPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 5930 S 58TH ST STE J
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City | LINCOLN
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State | NE
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Zip | 68516-3653
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Country | US
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Telephone | 402-623-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 19839 SW 100TH ST
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City | CRETE
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State | NE
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Zip | 68333-2593
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Country | US
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Telephone | 402-418-1540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9988
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5154
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License Number State | NE
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