Provider Demographics
NPI:1629896097
Name:MENOUSEK PSYCHOLOGY CONSULTATION, LLC
Entity type:Organization
Organization Name:MENOUSEK PSYCHOLOGY CONSULTATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MENOUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-704-6555
Mailing Address - Street 1:21050 GEORGE B LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4135
Mailing Address - Country:US
Mailing Address - Phone:402-704-6555
Mailing Address - Fax:
Practice Address - Street 1:8790 F ST STE 111
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1529
Practice Address - Country:US
Practice Address - Phone:402-704-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty