Provider Demographics
NPI:1134276793
Name:GALL, ROBERT (LMHP, LPC, LADC, MA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GALL
Suffix:
Gender:M
Credentials:LMHP, LPC, LADC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7202 GILES RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAVISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-6060
Mailing Address - Country:US
Mailing Address - Phone:402-612-3816
Mailing Address - Fax:402-614-4130
Practice Address - Street 1:7202 GILES RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LAVISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-6060
Practice Address - Country:US
Practice Address - Phone:402-612-3816
Practice Address - Fax:402-614-4130
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE583101YA0400X
NE2250101YM0800X
NE1255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional