Basic Information
| Provider Information | |||||||||
| NPI: | 1164666160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANAHAN | ||||||||
| FirstName: | GRETA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMHP, CPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 S 29TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685166056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024760104 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7100 S 29TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685166056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024760104 | ||||||||
| FaxNumber: | 4024382801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 8844Q | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.