Active NPI
Kimberly Ann Potter, MA,, LIMHP
- Mental Health Counselor
- Omaha, NE
National Provider Identifier
1609940402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2432
- Practice address
- 415 S 25TH St
Omaha, NE 68124 - Phone
- (402) 742-8857
- Fax
- (402) 477-0081
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | P-994 | NE | |
| Mental Health Counselor | 101YM0800X | 114 | NE | |
| Professional Counselor | 101YP2500X | 1330 | NE | |
| Mental Health Counselor | 101YM0800X | 2432 | NE | Primary |
Addresses
Primary practice location
415 S 25TH St
Omaha, NE 68124
Mailing address
415 South 25TH Street
Omaha, NE 68124
Phone (402) 717-5550
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 238599 | Other | NE | MIDLANDS CHOICE |
| 47052851581 | Medicaid | NE | |
| 47052851500 | Medicaid | NE | |
| 84988 | Other | NE | BCBS |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P-994 | NE | MD | Addiction (Substance Use Disorder) Counselor |
| 114 | NE | MD | Mental Health Counselor |
| 1330 | NE | MD | Mental Health Counselor |
| 2432 | NE | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KVC Behavioral Healthcare Nebraska, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Lincoln, NE
- NPI 1568790483
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622678400000",
"number": "1609940402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 SOUTH 25TH STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "68124",
"telephone_number": "402-717-5550",
"fax_number": "402-717-5792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 S 25TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "68124",
"telephone_number": "402-742-8857",
"fax_number": "402-477-0081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "MA,, LIMHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2021-06-03",
"certification_date": "2021-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NE",
"license": "P-994",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "114",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NE",
"license": "1330",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "2432",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "238599",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851581",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851500",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "84988",
"state": "NE"
}
],
"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 Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.