Provider Demographics
NPI:1659017192
Name:GILBERG, COURTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GILBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-2012
Mailing Address - Country:US
Mailing Address - Phone:918-527-0504
Mailing Address - Fax:
Practice Address - Street 1:620 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-2012
Practice Address - Country:US
Practice Address - Phone:918-527-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical