Active NPI
Justin Lee Ruzicka, PMHP, PLADC
- Mental Health Counselor
- Gering, NE
National Provider Identifier
1881263069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12631
- Practice address
- 116 Terry Blvd
Gering, NE 69341-1601 - Phone
- (308) 632-3981
- NPI assigned
- Jun 22, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | P-1869 | NE | |
| Mental Health Counselor | 101YM0800X | 12631 | NE | Primary |
Addresses
Primary practice location
116 Terry Blvd
Gering, NE 69341-1601
Mailing address
116 Terry Blvd
Gering, NE 69341-1601
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 |
|---|---|---|---|
| P-1869 | NE | MD | Addiction (Substance Use Disorder) Counselor |
| 12631 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624320000000",
"number": "1881263069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 TERRY BLVD",
"city": "GERING",
"state": "NE",
"postal_code": "693411601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 TERRY BLVD",
"city": "GERING",
"state": "NE",
"postal_code": "693411601",
"telephone_number": "308-632-3981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUZICKA",
"first_name": "JUSTIN",
"middle_name": "LEE",
"credential": "PMHP, PLADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-22",
"last_updated": "2021-06-22",
"certification_date": "2021-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NE",
"license": "P-1869",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "12631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gering, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.