NPIMap

Individual provider Active NPI

Robert Koley Jr., M.ED.

  • Counselor
  • Omaha, NE
National Provider Identifier
1861876773
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
522 Issued in NE
Practice address
920 S 107TH Ave
200
Omaha, NE 68114-4719
Phone
(402) 213-4086
Fax
(402) 333-5620
NPI assigned
Jul 10, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 522 NE Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X P-1260 NE
Professional Counselor 101YP2500X 485 NE

Addresses

Primary practice location

920 S 107TH Ave
200
Omaha, NE 68114-4719

Mailing address

920 S 107TH Ave
200
Omaha, NE 68114-4719
Phone (402) 213-4086

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 Education

State licenses

LicenseStateTypeSpecialty
P-1260NEMDAddiction (Substance Use Disorder) Counselor
485NEMDNutritionist
522NEMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1861876773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 S 107TH AVE",
            "address_2": "200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144719",
            "telephone_number": "402-213-4086",
            "fax_number": "402-333-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 S 107TH AVE",
            "address_2": "200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144719",
            "telephone_number": "402-213-4086",
            "fax_number": "402-333-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLEY",
        "first_name": "ROBERT",
        "name_suffix": "Jr.",
        "credential": "M.ED.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-10",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NE",
            "license": "522",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NE",
            "license": "P-1260",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NE",
            "license": "485",
            "primary": false
        }
    ],
    "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 Jul 10, 2015; 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.