Provider Demographics
NPI:1720188311
Name:MYERS, CARL RAY JR (LMHP, LADC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RAY
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-0028
Mailing Address - Country:US
Mailing Address - Phone:402-932-0666
Mailing Address - Fax:402-932-1376
Practice Address - Street 1:1410 E GOLD COAST RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5799
Practice Address - Country:US
Practice Address - Phone:402-932-0666
Practice Address - Fax:406-932-1376
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE035101YA0400X
NE139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025611700Medicaid