Provider Demographics
NPI:1679764195
Name:GILKERSON, LAUREN Q (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:Q
Last Name:GILKERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:JANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 MAVERICK DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9717
Mailing Address - Country:US
Mailing Address - Phone:406-425-2494
Mailing Address - Fax:
Practice Address - Street 1:425 W LOUCKS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4128
Practice Address - Country:US
Practice Address - Phone:307-672-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0503919824117101Y00000X
WY374101YP2500X
MNCC00384101YP2500X
WY1332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor