Active NPI
Shane M Berry, LIMHP, LADC
- Mental Health Counselor
- Omaha, NE
National Provider Identifier
1881720290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1254
- Practice address
- 12020 Shamrock PLZ Ste 200
Omaha, NE 68154-3537 - Phone
- (402) 522-6570
- Fax
- (402) 625-0410
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 1116 | NE | |
| Mental Health Counselor | 101YM0800X | 1254 | NE | Primary |
Addresses
Primary practice location
12020 Shamrock PLZ Ste 200
Omaha, NE 68154-3537
Mailing address
12020 Shamrock PLZ Ste 200
Omaha, NE 68154-3537
Phone (402) 522-6570
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 |
|---|---|---|---|
| 1254 | NE | MD | Optometrist |
| 1116 | NE | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1881720290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12020 SHAMROCK PLZ STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681543537",
"telephone_number": "402-522-6570",
"fax_number": "402-625-0410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12020 SHAMROCK PLZ STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681543537",
"telephone_number": "402-522-6570",
"fax_number": "402-625-0410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "SHANE",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "LIMHP, LADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2023-09-06",
"certification_date": "2023-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NE",
"license": "1116",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "1254",
"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 Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.