Provider Demographics
NPI:1396158788
Name:MEYER, SHANE (LIMHP)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 S 48TH ST STE 215A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4139
Mailing Address - Country:US
Mailing Address - Phone:402-802-2476
Mailing Address - Fax:
Practice Address - Street 1:5561 S 48TH ST STE 215A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4139
Practice Address - Country:US
Practice Address - Phone:402-802-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10259101YM0800X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075636930Medicaid
NE098935Medicare UPIN