Provider Demographics
NPI:1528050663
Name:MCCALLIE, KENDRA KAY (LCSW LMHP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:KAY
Last Name:MCCALLIE
Suffix:
Gender:F
Credentials:LCSW LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12746 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2803
Mailing Address - Country:US
Mailing Address - Phone:402-292-0136
Mailing Address - Fax:
Practice Address - Street 1:1246 GOLDEN GATE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2838
Practice Address - Country:US
Practice Address - Phone:402-339-2544
Practice Address - Fax:402-339-4358
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2612101YM0800X
NE10791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
279282Medicare PIN