Provider Demographics
NPI:1932610524
Name:GILCHRIST, BREANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 CRIPPLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2970
Mailing Address - Country:US
Mailing Address - Phone:479-657-8100
Mailing Address - Fax:
Practice Address - Street 1:1919 S 40TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5247
Practice Address - Country:US
Practice Address - Phone:479-657-8100
Practice Address - Fax:479-777-9988
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3088101YM0800X
NE74021041C0700X
AR7402-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229599719Medicaid