Provider Demographics
NPI:1538726310
Name:MARK, CHRISTINA (PHD, LP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MONACHINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:18021 OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6035
Mailing Address - Country:US
Mailing Address - Phone:402-986-6250
Mailing Address - Fax:402-702-1584
Practice Address - Street 1:18021 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6035
Practice Address - Country:US
Practice Address - Phone:402-986-6250
Practice Address - Fax:402-702-1584
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist