Provider Demographics
NPI:1578647954
Name:DOBBERSTEIN, KELLY S (PLMHP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:S
Last Name:DOBBERSTEIN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8429
Mailing Address - Country:US
Mailing Address - Phone:308-233-5317
Mailing Address - Fax:
Practice Address - Street 1:207 W 29TH ST
Practice Address - Street 2:STE B
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3475
Practice Address - Country:US
Practice Address - Phone:308-338-8900
Practice Address - Fax:308-338-8906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025460300Medicaid
NE98734OtherBLUE CROSS BLUE SHIELD