Active NPI
Stephanie Radda
- Mental Health Counselor
- Omaha, NE
National Provider Identifier
1154176980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3708
- Practice address
- 11220 Fort St
Omaha, NE 68164-2120 - Phone
- (402) 490-1762
- NPI assigned
- Apr 23, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3708 | NE | Primary |
Addresses
Primary practice location
11220 Fort St
Omaha, NE 68164-2120
Mailing address
11220 Fort St Ste 102
Omaha, NE 68164-2120
Phone (402) 490-1762
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3708 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733443200000",
"number": "1154176980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11220 FORT ST STE 102",
"city": "OMAHA",
"state": "NE",
"postal_code": "681642120",
"telephone_number": "402-490-1762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11220 FORT ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681642120",
"telephone_number": "402-490-1762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADDA",
"first_name": "STEPHANIE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-23",
"last_updated": "2024-12-06",
"certification_date": "2024-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "3708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.