Provider Demographics
NPI:1992120950
Name:BOS, GAIL L (PC, LMHP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:BOS
Suffix:
Gender:F
Credentials:PC, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11785 N 175TH CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-5712
Mailing Address - Country:US
Mailing Address - Phone:402-960-2500
Mailing Address - Fax:
Practice Address - Street 1:14441 DUPONT CT STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2107
Practice Address - Country:US
Practice Address - Phone:402-960-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4081101YM0800X
NE2009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional