Provider Demographics
NPI:1790850311
Name:GAINES, DAVID T (LMHP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:GAINES
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2423
Mailing Address - Country:US
Mailing Address - Phone:402-968-6050
Mailing Address - Fax:
Practice Address - Street 1:4809 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2423
Practice Address - Country:US
Practice Address - Phone:402-968-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025103800Medicaid