Provider Demographics
NPI:1871689646
Name:BURGER, ROD (LMHP)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:BURGER
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 S. 84TH ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127
Mailing Address - Country:US
Mailing Address - Phone:402-339-7991
Mailing Address - Fax:402-339-7624
Practice Address - Street 1:6550 S. 84TH ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127
Practice Address - Country:US
Practice Address - Phone:402-339-7991
Practice Address - Fax:402-339-7624
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470804773-26Medicaid
NE113511000OtherMEDICAID MIS #