Provider Demographics
NPI:1366722282
Name:MARSHALL, CHRISTOPHER LYNN (PLMHP, PLADC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 507
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2945
Mailing Address - Country:US
Mailing Address - Phone:531-867-7455
Mailing Address - Fax:531-466-8610
Practice Address - Street 1:4732 S 131ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1822
Practice Address - Country:US
Practice Address - Phone:402-697-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9019101YM0800X
NEP-1785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026845900Medicaid