Provider Demographics
NPI:1841655990
Name:GILBERT, JOHN NICHOLAS (PEER SPECIALIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 S HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:BIG CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40914-8938
Mailing Address - Country:US
Mailing Address - Phone:606-598-5551
Mailing Address - Fax:
Practice Address - Street 1:5800 SOUTH HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:BIG CREEK
Practice Address - State:KY
Practice Address - Zip Code:40914
Practice Address - Country:US
Practice Address - Phone:606-598-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)