Provider Demographics
NPI:1568794329
Name:GILBERTSON, NICOLE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:BRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3960 PATIENT CARE WAY STE 104
Mailing Address - Street 2:STE 104
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4276
Mailing Address - Country:US
Mailing Address - Phone:517-887-9801
Mailing Address - Fax:517-887-9826
Practice Address - Street 1:3960 PATIENT CARE WAY STE 104
Practice Address - Street 2:STE 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4276
Practice Address - Country:US
Practice Address - Phone:517-887-9801
Practice Address - Fax:517-887-9826
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical