Active NPI
Mary Irene Roeder, MA, PLMHP
- Professional Counselor
- Omaha, NE
National Provider Identifier
1760134266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 12765
- Practice address
- 11071 W Maple Rd
Omaha, NE 68164-2604 - Phone
- (402) 932-8884
- Fax
- (402) 932-8885
- NPI assigned
- Jan 25, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 12765 | NE | Primary |
Addresses
Primary practice location
11071 W Maple Rd
Omaha, NE 68164-2604
Mailing address
PO Box 75
Blair, NE 68008-0075
Phone (402) 427-3815
Other practice location 1
11099 Ramble Ridge Dr
Blair, NE 68008-7562
Phone (402) 427-3815
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 |
|---|---|---|---|
| 12765 | NE | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643068800000",
"number": "1760134266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 75",
"city": "BLAIR",
"state": "NE",
"postal_code": "680080075",
"telephone_number": "402-427-3815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11071 W MAPLE RD",
"city": "OMAHA",
"state": "NE",
"postal_code": "681642604",
"telephone_number": "402-932-8884",
"fax_number": "402-932-8885"
}
],
"practiceLocations": [
{
"address_1": "11099 Ramble Ridge Dr",
"address_purpose": "LOCATION",
"city": "Blair",
"state": "NE",
"postal_code": "680087562",
"country_code": "US",
"telephone_number": "402-427-3815",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROEDER",
"first_name": "MARY",
"middle_name": "IRENE",
"name_prefix": "Mrs.",
"credential": "MA, PLMHP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-25",
"last_updated": "2022-01-25",
"certification_date": "2022-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NE",
"license": "12765",
"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 Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.