Provider Demographics
NPI:1518458413
Name:MCMANN, MARSHA LEA (LIMHP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LEA
Last Name:MCMANN
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:HALL
Other - Last Name:MCMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:19507 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3248
Mailing Address - Country:US
Mailing Address - Phone:512-350-2888
Mailing Address - Fax:
Practice Address - Street 1:19507 ADAMS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3248
Practice Address - Country:US
Practice Address - Phone:512-350-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3461041C0700X
NE1372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1372OtherLICENSED INDEPENDENT MENTAL HEALTH PRACTITIONER