1093854127 NPI number — MRS. KATHRYN RENEE EILERS LCSW

Table of content: MRS. KATHRYN RENEE EILERS LCSW (NPI 1093854127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093854127 NPI number — MRS. KATHRYN RENEE EILERS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EILERS
Provider First Name:
KATHRYN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUERLY
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093854127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5905 O ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-436-1301
Provider Business Mailing Address Fax Number:
402-458-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2229 J ST
Provider Second Line Business Practice Location Address:
COUNSELING CENTER
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-6851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-436-1301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3287 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1254 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 97109 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".