Healthcare Provider Details

I. General information

NPI: 1043728751
Provider Name (Legal Business Name): GAYLE NEUERBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 05/14/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 NORTHWAY DR STE 110
SAINT CLOUD MN
56303-1274
US

IV. Provider business mailing address

1736 LUCILLE LN
SAINT CLOUD MN
56303-0432
US

V. Phone/Fax

Practice location:
  • Phone: 218-721-2982
  • Fax:
Mailing address:
  • Phone: 218-721-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2443
License Number StateMN

VIII. Authorized Official

Name: MRS. GAYLE LINDA NEUERBURG
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 218-721-2982