MEDICARE: MENOUSEK PSYCHOLOGY CONSULTATION, LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1629896097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENOUSEK PSYCHOLOGY CONSULTATION, LLC

Provider Business Mailing Address
First Line	:	21050 GEORGE B LAKE PKWY
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4135
Country	:	US
Telephone Number	:	402-704-6555
Fax Number	:

Provider Business Practice Location Address
First Line	:	8790 F ST STE 111
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1529
Country	:	US
Telephone Number	:	402-704-6555
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. KATHRYN MARIE MENOUSEK
Credential	:	PH.D.
Telephone Number	:	402-704-6555

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/21/2024

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