Basic Information
| Provider Information | |||||||||
| NPI: | 1528050663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCALLIE | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | LCSW LMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12746 S 38TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681232803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022920136 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1246 GOLDEN GATE DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680462838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023392544 | ||||||||
| FaxNumber: | 4023394358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 11/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2612 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 1079 | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.