Provider Demographics
NPI:1922392869
Name:GATEWAY COUNSELING, INC
Entity Type:Organization
Organization Name:GATEWAY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-242-3771
Mailing Address - Street 1:427 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3016
Mailing Address - Country:US
Mailing Address - Phone:208-242-3771
Mailing Address - Fax:208-242-3772
Practice Address - Street 1:427 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3016
Practice Address - Country:US
Practice Address - Phone:208-242-3771
Practice Address - Fax:208-242-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-28906101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty