Provider Demographics
NPI:1972241271
Name:MCCASKILL, GABRIELLE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:MCCASKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5913
Mailing Address - Country:US
Mailing Address - Phone:772-267-2855
Mailing Address - Fax:
Practice Address - Street 1:56159 RIVERDALE DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1144
Practice Address - Country:US
Practice Address - Phone:888-537-5733
Practice Address - Fax:888-847-0805
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00000171M00000X
IN99121931A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN99121931AOtherTEMP MENTAL HEALTH COUNSELOR ASSOCIATE LICENSURE