Provider Demographics
NPI:1528325511
Name:CARRIE L. GOTTSCHALK, P.C.
Entity type:Organization
Organization Name:CARRIE L. GOTTSCHALK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GOTTSCHALK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-515-3312
Mailing Address - Street 1:2258 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-6016
Mailing Address - Country:US
Mailing Address - Phone:402-515-3312
Mailing Address - Fax:
Practice Address - Street 1:2258 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-6016
Practice Address - Country:US
Practice Address - Phone:402-515-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026204000Medicaid