Basic Information
Provider Information | |||||||||
NPI: | 1407407307 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GILMER | ||||||||
FirstName: | BRITNEE | ||||||||
MiddleName: | SARAH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | BCBA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PICKETT | ||||||||
OtherFirstName: | BRITNEE | ||||||||
OtherMiddleName: | SARAH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1105 W RUSSELL ST | ||||||||
Address2: |   | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571041322 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 0562712690 | ||||||||
FaxNumber: | 6052713956 | ||||||||
Practice Location | |||||||||
Address1: | 21230 KINGSLAND BLVD # 100A | ||||||||
Address2: |   | ||||||||
City: | KATY | ||||||||
State: | TX | ||||||||
PostalCode: | 774505899 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8323425841 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/23/2019 | ||||||||
LastUpdateDate: | 05/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/10/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 37091 | TX | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.