Active NPI
Carol Countryman Nunnally, LCSW LIMHP
- Mental Health Counselor
- Lincoln, NE
National Provider Identifier
1093876872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 67
- Practice address
- 4444 S 86TH T Ste 102
Lincoln, NE 68526-9253 - Phone
- (402) 476-7557
- Fax
- (402) 476-9912
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1136 | NE | |
| Mental Health Counselor | 101YM0800X | 67 | NE | Primary |
Addresses
Primary practice location
4444 S 86TH T Ste 102
Lincoln, NE 68526-9253
Mailing address
PO Box 57475
Lincoln, NE 68505
Phone (402) 429-5365
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85299 | Other | NE | BCBS |
| 10025273400 | Medicaid | NE | |
| 798299000 | Other | NE | MAGELLAN |
Other names 1
- Carol Countryman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1136 | NE | MD | Counselor |
| 67 | NE | MD | Advanced Practice Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698192000000",
"number": "1093876872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 57475",
"city": "LINCOLN",
"state": "NE",
"postal_code": "68505",
"telephone_number": "402-429-5365",
"fax_number": "402-476-9912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 S 86TH T STE 102",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685269253",
"telephone_number": "402-476-7557",
"fax_number": "402-476-9912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUNNALLY",
"first_name": "CAROL",
"middle_name": "COUNTRYMAN",
"name_prefix": "Ms.",
"credential": "LCSW LIMHP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2023-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "1136",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "67",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "85299",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025273400",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "798299000",
"state": "NE"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CAROL",
"last_name": "COUNTRYMAN",
"credential": "LCSW, LIMHP",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.