Provider Demographics
NPI:1366891756
Name:GORSETT, JANENE
Entity type:Individual
Prefix:
First Name:JANENE
Middle Name:
Last Name:GORSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANENE
Other - Middle Name:
Other - Last Name:GORSETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:125 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SMITHLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51056-8637
Mailing Address - Country:US
Mailing Address - Phone:712-256-7888
Mailing Address - Fax:712-256-6502
Practice Address - Street 1:3650 GLEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1546
Practice Address - Country:US
Practice Address - Phone:712-222-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2144101YP2500X
IA083013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LP6307OtherSTATE OF MINNESOTA BOARD OF PSYCHOLOGY
MNLP6307Medicaid