Provider Demographics
NPI:1881720290
Name:BERRY, SHANE M (LIMHP, LADC)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:M
Last Name:BERRY
Suffix:
Gender:M
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12020 SHAMROCK PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3537
Mailing Address - Country:US
Mailing Address - Phone:402-522-6570
Mailing Address - Fax:402-625-0410
Practice Address - Street 1:12020 SHAMROCK PLZ STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3537
Practice Address - Country:US
Practice Address - Phone:402-522-6570
Practice Address - Fax:402-625-0410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1116101YA0400X
NE1254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)