NPIMap

Organization Active NPI

Omaha Mental Health LLC

  • Mental Health Counselor
  • Omaha, NE
National Provider Identifier
1164023321
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
OMAHA MENTAL HEALTH LLC
Practice address
12305 Gold St Ste 13
Omaha, NE 68144-2760
Phone
(402) 709-1496
NPI assigned
Nov 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sergio Matt PalomoNPI 1871902395
Title
Owner
Phone
(402) 709-1496

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

12305 Gold St Ste 13
Omaha, NE 68144-2760

Mailing address

12305 Gold St Ste 13
Omaha, NE 68144-2760
Phone (402) 709-1496

Other identifiers 1

IdentifierTypeStateIssuer
10026800600MedicaidNE

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Omahamentalhealth.com Direct

National Provider Directory

National Provider Directory

Locations

12305 Gold St
Ste 13
Omaha, NE 68144
Phone (402) 709-1496

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1164023321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12305 GOLD ST STE 13",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681442760",
            "telephone_number": "402-709-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12305 GOLD ST STE 13",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681442760",
            "telephone_number": "402-709-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMAHA MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "PALOMO",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_middle_name": "MATT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-709-1496"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026800600",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Omahamentalhealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12305 Gold St Ste 13",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681442760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nov 4, 2020; 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.