Individual provider Active NPI

Dezirae McEvoy, LICSW

  • Mental Health Counselor
  • Lincoln, NE
National Provider Identifier
1861940496
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
2053 Issued in NE
Practice address
4344 N 62ND St Ste 5
Lincoln, NE 68507-1251
Phone
(308) 360-2444
NPI assigned
Sep 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2053 NE Primary
Clinical Social Worker 1041C0700X 1769 NE

Addresses

Primary practice location

4344 N 62ND St Ste 5
Lincoln, NE 68507-1251

Mailing address

4344 N 62ND St Ste 5
Lincoln, NE 68507-1251
Phone (308) 360-2444

Other identifiers 3

IdentifierTypeStateIssuer
11007OtherNENE PLMHP LICENSURE
1769OtherNENEBRASKA LICENSED MASTER SOCIAL WORKER
2053OtherNENEBRASKA LICENSED INDEPENDENT MENTAL HEALTH PRACTITIONER (LIMHP)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190717000352 NE Practitioner - Clinical Social Worker 1850626664 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4344 N 62ND St
Suite 5
Lincoln, NE 68507-1215
Phone (308) 360-2444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2053NEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Holistic Healing Counseling Center, LLC CurrentSince Feb 1, 2023 Accepting new patients

Locations

4344 N 62nd St
Ste 5
Lincoln, NE 68507
Phone (308) 360-2444

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1861940496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4344 N 62ND ST STE 5",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685071251",
            "telephone_number": "308-360-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4344 N 62ND ST STE 5",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685071251",
            "telephone_number": "308-360-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCEVOY",
        "first_name": "DEZIRAE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-12",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "2053",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "1769",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NE PLMHP LICENSURE",
            "identifier": "11007",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA LICENSED MASTER SOCIAL WORKER",
            "identifier": "1769",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA LICENSED INDEPENDENT MENTAL HEALTH PRACTITIONER (LIMHP)",
            "identifier": "2053",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.