Provider Demographics
NPI:1396048609
Name:SISK, GAYLA D (LCSW)
Entity type:Individual
Prefix:
First Name:GAYLA
Middle Name:D
Last Name:SISK
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 1:5270 FLAT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2224
Mailing Address - Country:US
Mailing Address - Phone:573-431-0162
Mailing Address - Fax:
Practice Address - Street 1:5270 FLAT RIVER DR
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2224
Practice Address - Country:US
Practice Address - Phone:573-431-0162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100030181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical