Provider Demographics
NPI:1942014733
Name:PICKELL, MARCIA RAE
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:RAE
Last Name:PICKELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 COUNTY ROAD 27
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:NE
Mailing Address - Zip Code:68020-2126
Mailing Address - Country:US
Mailing Address - Phone:402-307-0178
Mailing Address - Fax:
Practice Address - Street 1:1874 COUNTY ROAD 27
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:NE
Practice Address - Zip Code:68020-2126
Practice Address - Country:US
Practice Address - Phone:402-307-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities