Provider Demographics
NPI:1578817011
Name:THOMAS, CHRISTINA JO (PLMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JO
Last Name:THOMAS
Suffix:
Gender:F
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 1:210 GATEWAY MALL
Mailing Address - Street 2:342
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2489
Mailing Address - Country:US
Mailing Address - Phone:402-434-2745
Mailing Address - Fax:
Practice Address - Street 1:210 GATEWAY MALL
Practice Address - Street 2:342
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2489
Practice Address - Country:US
Practice Address - Phone:402-434-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9469101Y00000X
NEP-1052101YA0400X
NE261QM0801X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025734000Medicaid
NE10026038300Medicaid
NE47075636930Medicaid