Provider Demographics
NPI:1699664656
Name:GABISSA LLC
Entity type:Organization
Organization Name:GABISSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-825-7705
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-0478
Mailing Address - Country:US
Mailing Address - Phone:314-825-7705
Mailing Address - Fax:
Practice Address - Street 1:438 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2434
Practice Address - Country:US
Practice Address - Phone:314-825-7705
Practice Address - Fax:833-542-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty