Provider Demographics
NPI:1285986281
Name:PHOSALY KLITGAARD, LINDA (PHD, LP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PHOSALY KLITGAARD
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PHOSALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13460 WALSH DR
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7529
Mailing Address - Country:US
Mailing Address - Phone:531-355-3358
Mailing Address - Fax:531-355-3375
Practice Address - Street 1:13460 WALSH DR
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7529
Practice Address - Country:US
Practice Address - Phone:531-355-3358
Practice Address - Fax:531-355-3375
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5367101Y00000X
NE605101Y00000X
NE1016103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor