Provider Demographics
NPI:1629104435
Name:GAINES, DENISE J (LIMHP, LADC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:J
Last Name:GAINES
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S 17TH ST STE 233
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1919
Mailing Address - Country:US
Mailing Address - Phone:402-203-6203
Mailing Address - Fax:
Practice Address - Street 1:319 S 17TH ST STE 233
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1919
Practice Address - Country:US
Practice Address - Phone:402-203-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE847101YA0400X
NE886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025003000Medicaid