Provider Demographics
NPI:1548447758
Name:DORFMEYER, KELLY R (MS, LIMHP, CPC, LADC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:DORFMEYER
Suffix:
Gender:F
Credentials:MS, LIMHP, CPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11905 P ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2237
Mailing Address - Country:US
Mailing Address - Phone:402-884-0856
Mailing Address - Fax:402-884-0865
Practice Address - Street 1:11905 P ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2237
Practice Address - Country:US
Practice Address - Phone:402-884-0856
Practice Address - Fax:402-884-0865
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE663101YA0400X
NE2982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)