Provider Demographics
NPI:1619150786
Name:GISH, VICKIE (MA, MFT, LADC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:GISH
Suffix:
Gender:F
Credentials:MA, MFT, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W PLUMB LN STE F
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3766
Mailing Address - Country:US
Mailing Address - Phone:775-690-7628
Mailing Address - Fax:775-327-6077
Practice Address - Street 1:421 W PLUMB LN STE F
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3766
Practice Address - Country:US
Practice Address - Phone:775-690-7628
Practice Address - Fax:775-327-6077
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01125106H00000X
NV01221-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)