Provider Demographics
NPI:1942721345
Name:GILKERSON COUNSELING & MEDIATION
Entity Type:Organization
Organization Name:GILKERSON COUNSELING & MEDIATION
Other - Org Name:GILKERSON COUNSELING & MEDIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:308-760-5041
Mailing Address - Street 1:6291 KEITH RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-5253
Mailing Address - Country:US
Mailing Address - Phone:308-760-5041
Mailing Address - Fax:308-217-4277
Practice Address - Street 1:815 FLACK AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2722
Practice Address - Country:US
Practice Address - Phone:308-762-2723
Practice Address - Fax:308-217-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid