Gary Lee Anderson Jr., AAS, PLADC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

P1502 Issued in NE

Practice address

11215 John Galt Blvd
Omaha, NE 68137-2319

Phone

(402) 592-5900

Fax

(402) 592-5901

NPI assigned

Jan 10, 2022

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Omaha Treatment Center, LLC

  • Methadone Clinic
  • Omaha, NE
  • NPI 1073874731
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 10, 2022.

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1134880313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11215 JOHN GALT BLVD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681372319",
            "telephone_number": "402-592-5900",
            "fax_number": "402-592-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11215 JOHN GALT BLVD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681372319",
            "telephone_number": "402-592-5900",
            "fax_number": "402-592-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "AAS, PLADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NE",
            "license": "P1502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073874731",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "omaha@methadonetreatmentcenter.com",
            "affiliation": "Y",
            "endpointDescription": "omaha@methadonetreatmentcenter.com",
            "affiliationName": "Omaha Treatment Center, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11215 John Galt Blvd",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681372319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donald G. Anderson, PT
• Dorothy J Anderson
• Elizabeth E Anderson, PA-C
• Elizabeth S Anderson, MS CCC SLP
• Erik Darnell Anderson Sr.
• Gina Lynn Anderson, PLMHP
• Gwen Anderson
• Haley Marie Anderson
• Heather Anderson
• Holly Anderson

• All providers in Omaha, NE
• Counselor in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.