Provider Demographics
NPI:1710941398
Name:EVANS, MARLEEN ELIZABETH (LPC LIMHP MA)
Entity Type:Individual
Prefix:MRS
First Name:MARLEEN
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC LIMHP MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 AUGUSTA AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3753
Mailing Address - Country:US
Mailing Address - Phone:402-330-1537
Mailing Address - Fax:402-330-9331
Practice Address - Street 1:12728 AUGUSTA AVE
Practice Address - Street 2:STE 150
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3753
Practice Address - Country:US
Practice Address - Phone:402-330-1537
Practice Address - Fax:402-330-9331
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470789060Medicaid
NE85069OtherBCBS OF NE
022480OtherVALUE OPTIONS
120644000OtherMAGELLAN