Provider Demographics
NPI:1699751768
Name:GONSHER, ALLAN M (LSCSW)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:M
Last Name:GONSHER
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-330-4014
Mailing Address - Fax:402-334-2930
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-330-4014
Practice Address - Fax:402-334-2930
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical