Provider Demographics
NPI:1659661130
Name:GILBERT, JAIME (LPC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:YOUNGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:408 N KENDRICK ST STE 4
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1582
Mailing Address - Country:US
Mailing Address - Phone:928-224-8268
Mailing Address - Fax:
Practice Address - Street 1:408 N KENDRICK ST STE 4
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1582
Practice Address - Country:US
Practice Address - Phone:928-224-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0601077101YP2500X
AZ22827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid