Healthcare Provider Details

I. General information

NPI: 1679764195
Provider Name (Legal Business Name): LAUREN Q GILKERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN JANEY

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W LOUCKS ST
SHERIDAN WY
82801-4128
US

IV. Provider business mailing address

44 MAVERICK DR
SHERIDAN WY
82801-9717
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-2468
  • Fax:
Mailing address:
  • Phone: 406-425-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0503919824117
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number374
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00384
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1332
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: