Provider Demographics
NPI:1043728751
Name:GAYLE NEUERBURG LLC
Entity type:Organization
Organization Name:GAYLE NEUERBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:NEUERBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:218-721-2982
Mailing Address - Street 1:1736 LUCILLE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0432
Mailing Address - Country:US
Mailing Address - Phone:218-721-2982
Mailing Address - Fax:
Practice Address - Street 1:1521 NORTHWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1274
Practice Address - Country:US
Practice Address - Phone:218-721-2982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MN2443251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1366878381OtherLMFT