Provider Demographics
NPI:1972482958
Name:MANKIN, MARK (PLMHP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MANKIN
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13304 W CENTER RD STE 126
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3457
Mailing Address - Country:US
Mailing Address - Phone:402-213-8131
Mailing Address - Fax:
Practice Address - Street 1:13304 W CENTER RD STE 126
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3457
Practice Address - Country:US
Practice Address - Phone:402-213-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty