Provider Demographics
NPI:1164926440
Name:SHIMKUS, GABRIELLE AP (LPC, BSC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:AP
Last Name:SHIMKUS
Suffix:
Gender:F
Credentials:LPC, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 VARSITY DR
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 VARSITY DR
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1446
Practice Address - Country:US
Practice Address - Phone:570-881-9806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003337103K00000X
PAPC008296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst