Healthcare Provider Details

I. General information

NPI: 1225039977
Provider Name (Legal Business Name): GAIL LYNN GABBERT D.MIN., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRING ST STE 101
GALENA IL
61036-2003
US

IV. Provider business mailing address

800 SPRING ST STE 101
GALENA IL
61036-2003
US

V. Phone/Fax

Practice location:
  • Phone: 815-777-2850
  • Fax: 815-550-0529
Mailing address:
  • Phone: 815-777-2850
  • Fax: 815-550-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166-000220
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: