Provider Demographics
NPI:1902610611
Name:SMALLEY, KAYLEE KRISTINE (LIMHP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:KRISTINE
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1323
Mailing Address - Country:US
Mailing Address - Phone:218-348-7166
Mailing Address - Fax:
Practice Address - Street 1:3403 N 191ST AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3350
Practice Address - Country:US
Practice Address - Phone:402-625-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health