Provider Demographics
NPI:1861221830
Name:MACK, GINA LYNN (PLMHP, PLCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LYNN
Last Name:MACK
Suffix:
Gender:F
Credentials:PLMHP, PLCSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LYNN
Other - Last Name:SAKARIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12512 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5209
Mailing Address - Country:US
Mailing Address - Phone:402-212-2978
Mailing Address - Fax:
Practice Address - Street 1:9239 W CENTER RD STE 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1900
Practice Address - Country:US
Practice Address - Phone:402-354-8005
Practice Address - Fax:402-354-8046
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80001041C0700X
NE13824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical