Active NPI
Michael L. Renner, LIMHP
- Mental Health Counselor
- Crete, NE
National Provider Identifier
1669619904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1020
- Practice address
- 1212 Ivy Ave
Ste 2
Crete, NE 68333-2301 - Phone
- (402) 826-2000
- Fax
- (402) 826-2655
- NPI assigned
- Jan 8, 2009
- Sex
- Male
- 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 | 1020 | NE | Primary |
Addresses
Primary practice location
1212 Ivy Ave
Ste 2
Crete, NE 68333-2301
Mailing address
PO Box 326
Crete, NE 68333-0326
Phone (402) 826-2000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47052851582 | Medicaid | NE | |
| 10025208300 | Medicaid | NE | |
| 47052851509 | Medicaid | NE | |
| 47052851507 | Medicaid | NE | |
| 47052851505 | Medicaid | NE | |
| 10025207900 | Medicaid | NE |
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 |
|---|---|---|---|
| 1020 | NE | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Valley Behavioral Health 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
- Beatrice, NE
- NPI 1316019508
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344297600000",
"number": "1669619904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 326",
"city": "CRETE",
"state": "NE",
"postal_code": "683330326",
"telephone_number": "402-826-2000",
"fax_number": "402-826-2655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 IVY AVE",
"address_2": "STE 2",
"city": "CRETE",
"state": "NE",
"postal_code": "683332301",
"telephone_number": "402-826-2000",
"fax_number": "402-826-2655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENNER",
"first_name": "MICHAEL",
"middle_name": "L.",
"credential": "LIMHP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-08",
"last_updated": "2012-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "1020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851582",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025208300",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851509",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851507",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47052851505",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025207900",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crete, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.