NPIMap

Organization Active NPI

Renewed Vision Counseling and Developmental Disability Center PC

  • Mental Health Counselor
  • Omaha, NE
National Provider Identifier
1174122170
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
RENEWED VISION COUNSELING AND DEVELOPMENTAL DISABILITY CENTER PC
Practice address
4610 S. 133Rd St
Suite 106
Omaha, NE 68137-1133
Phone
(402) 275-6413
NPI assigned
Oct 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Marshall, PLMHPNPI 1366722282
Title
Owner
Phone
(531) 876-7455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Developmentally Disabled Services Day Training Agency 251C00000X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X

Addresses

Primary practice location

4610 S. 133Rd St
Suite 106
Omaha, NE 68137-1133

Mailing address

4642 S. 132ND St
Omaha, NE 68137-1764
Phone (531) 876-7455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250304001307 NE Part B Supplier - Clinic/Group Practice 1658892914 Receives reassigned benefits from 3 practitioners
Practice locations: Omaha, NE

National Provider Directory

National Provider Directory

Locations

1941 S 42nd St
Ste 507
Omaha, NE 68105
Phone (888) 218-8131

4610 S 133rd St
Ste 106
Omaha, NE 68137
Phone (402) 275-6413

4642 S 132nd St
Omaha, NE 68137
Phone (402) 515-6668

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1174122170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4642 S. 132ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681371764",
            "telephone_number": "531-876-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 S. 133RD ST",
            "address_2": "SUITE 106",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681371133",
            "telephone_number": "402-275-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED VISION COUNSELING AND DEVELOPMENTAL DISABILITY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-21",
        "last_updated": "2025-02-26",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "531-876-7455",
        "authorized_official_credential": "PLMHP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.