Provider Demographics
NPI:1407913411
Name:CHRIST-ANDERSON, MARY ELLEN (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY ELLEN
Middle Name:
Last Name:CHRIST-ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 FARNAM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4673
Mailing Address - Country:US
Mailing Address - Phone:402-392-1922
Mailing Address - Fax:402-933-0613
Practice Address - Street 1:7330 FARNAM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4673
Practice Address - Country:US
Practice Address - Phone:402-392-1922
Practice Address - Fax:402-933-0613
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1003 AND 855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073983200Medicaid
NE84475OtherBLUE CROSS BLUE SHIELD