Provider Demographics
NPI:1942041058
Name:GILBERT, GRENDA NYAMOITA (LADC, PL-LPCC)
Entity type:Individual
Prefix:
First Name:GRENDA
Middle Name:NYAMOITA
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LADC, PL-LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1820
Mailing Address - Country:US
Mailing Address - Phone:952-254-0859
Mailing Address - Fax:
Practice Address - Street 1:1400 ENERGY PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5272
Practice Address - Country:US
Practice Address - Phone:952-245-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health