Provider Demographics
NPI:1740554757
Name:NEIKIRK, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:NEIKIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, BCBA-D
Mailing Address - Street 1:33562 YUCAIPA BLVD # 4-133
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2072
Mailing Address - Country:US
Mailing Address - Phone:909-583-4040
Mailing Address - Fax:909-217-3456
Practice Address - Street 1:33562 YUCAIPA BLVD # 4-133
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2072
Practice Address - Country:US
Practice Address - Phone:909-583-4040
Practice Address - Fax:909-217-3456
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7155103K00000X
CAPSY18601103T00000X, 103TC0700X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities