Basic Information
Provider Information | |||||||||
NPI: | 1891873220 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MYERS | ||||||||
FirstName: | BRUCE | ||||||||
MiddleName: | EDWARD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMHP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1410 E GOLD COAST RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | PAPILLION | ||||||||
State: | NE | ||||||||
PostalCode: | 680465799 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4025920639 | ||||||||
FaxNumber: | 4025920014 | ||||||||
Practice Location | |||||||||
Address1: | 124 S 24TH ST | ||||||||
Address2: | SUITE 230 | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681021226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4029785656 | ||||||||
FaxNumber: | 4025915075 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2006 | ||||||||
LastUpdateDate: | 11/10/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1429 | NE | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 764 | NE | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 539 | NE | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.