Provider Demographics
NPI:1417415621
Name:ROOT, PERRY JAMES SR (LIMHP, CMSW, PLADC)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:JAMES
Last Name:ROOT
Suffix:SR
Gender:M
Credentials:LIMHP, CMSW, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 N 103RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1010
Mailing Address - Country:US
Mailing Address - Phone:402-215-7327
Mailing Address - Fax:402-496-9609
Practice Address - Street 1:5421 N 103RD ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1010
Practice Address - Country:US
Practice Address - Phone:402-915-0599
Practice Address - Fax:402-496-9609
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7342104100000X
NE117661041C0700X
NE2815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health