Provider Demographics
NPI:1336771252
Name:EMILY GISLASON LLC
Entity Type:Organization
Organization Name:EMILY GISLASON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GISLASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MH
Authorized Official - Phone:605-830-0654
Mailing Address - Street 1:2200 S FIRESTONE LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-8512
Mailing Address - Country:US
Mailing Address - Phone:605-830-0654
Mailing Address - Fax:
Practice Address - Street 1:3101 W 41ST ST STE 201B
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-8144
Practice Address - Country:US
Practice Address - Phone:605-799-6182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty