Individual provider Active NPI

Carl Ray Myers Jr., LMHP, LADC

  • Mental Health Counselor
  • Papillion, NE
National Provider Identifier
1720188311
Registry record updated Aug 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
139 Issued in NE
Practice address
1410 E Gold Coast Rd
Suite 500
Papillion, NE 68046-5799
Phone
(402) 932-0666
Fax
(406) 932-1376
NPI assigned
Sep 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 035 NE
Mental Health Counselor 101YM0800X 139 NE Primary

Addresses

Primary practice location

1410 E Gold Coast Rd
Suite 500
Papillion, NE 68046-5799

Mailing address

PO Box 28
Plattsmouth, NE 68048-0028
Phone (402) 932-0666

Other identifiers 1

IdentifierTypeStateIssuer
10025611700MedicaidNE

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

LicenseStateTypeSpecialty
139NEMDMental Health Counselor
035NEMDAudiologist

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281139200000",
    "number": "1720188311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28",
            "city": "PLATTSMOUTH",
            "state": "NE",
            "postal_code": "680480028",
            "telephone_number": "402-932-0666",
            "fax_number": "402-932-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 E GOLD COAST RD",
            "address_2": "SUITE 500",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680465799",
            "telephone_number": "402-932-0666",
            "fax_number": "406-932-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "CARL",
        "middle_name": "RAY",
        "name_suffix": "Jr.",
        "credential": "LMHP, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2010-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NE",
            "license": "035",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025611700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Papillion, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2010; 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.