Provider Demographics
NPI:1932814324
Name:CRELLIN, SHANNON MARIE (AAS, PLADC, CDGC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:CRELLIN
Suffix:
Gender:F
Credentials:AAS, PLADC, CDGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S 70TH ST STE 217
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2467
Mailing Address - Country:US
Mailing Address - Phone:531-333-3166
Mailing Address - Fax:
Practice Address - Street 1:237 SOUTH 70TH STREET
Practice Address - Street 2:SUITE 217, OFFICE 4
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2467
Practice Address - Country:US
Practice Address - Phone:531-333-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2037101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)