Active NPI
Lacy Rudder, PLDAC
- Addiction (Substance Use Disorder) Counselor
- Omaha, NE
National Provider Identifier
1669169322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- P-2056
- Practice address
- 8502 Mormon Bridge Rd
Omaha, NE 68152-1929 - Phone
- (402) 991-8518
- Fax
- (402) 455-7050
- NPI assigned
- Apr 21, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | P-2056 | NE | Primary |
Addresses
Primary practice location
8502 Mormon Bridge Rd
Omaha, NE 68152-1929
Mailing address
8502 Mormon Bridge Rd
Omaha, NE 68152-1929
Phone (402) 991-8518
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 |
|---|---|---|---|
| P-2056 | NE | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682035200000",
"number": "1669169322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8502 MORMON BRIDGE RD",
"city": "OMAHA",
"state": "NE",
"postal_code": "681521929",
"telephone_number": "402-991-8518",
"fax_number": "402-455-7050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8502 MORMON BRIDGE RD",
"city": "OMAHA",
"state": "NE",
"postal_code": "681521929",
"telephone_number": "402-991-8518",
"fax_number": "402-455-7050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDDER",
"first_name": "LACY",
"credential": "PLDAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-21",
"last_updated": "2023-04-21",
"certification_date": "2023-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NE",
"license": "P-2056",
"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 Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.