Provider Demographics
NPI:1295857019
Name:ALLERHEILIGEN, GILBERT R (LCSW, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:ALLERHEILIGEN
Suffix:
Gender:M
Credentials:LCSW, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 COUNTY ROAD 3610
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-8100
Mailing Address - Country:US
Mailing Address - Phone:573-265-7496
Mailing Address - Fax:573-265-7496
Practice Address - Street 1:14600 COUNTY ROAD 3610
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-8100
Practice Address - Country:US
Practice Address - Phone:573-265-7496
Practice Address - Fax:573-265-7496
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001241101YP2500X
MO0003271041C0700X
MO300048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist