Provider Demographics
NPI:1528257870
Name:CRISMAN, GRETTA RENEE (LMHP)
Entity type:Individual
Prefix:MRS
First Name:GRETTA
Middle Name:RENEE
Last Name:CRISMAN
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 ELM ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4443
Mailing Address - Country:US
Mailing Address - Phone:402-330-4440
Mailing Address - Fax:402-952-0050
Practice Address - Street 1:11912 ELM ST
Practice Address - Street 2:SUITE 122
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4443
Practice Address - Country:US
Practice Address - Phone:402-330-4440
Practice Address - Fax:402-952-0050
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470542534-01Medicaid