Provider Demographics
NPI:1902496151
Name:JOUBERT, GAIL H
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:H
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:H
Other - Last Name:BERTHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 S CUSHMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7516
Mailing Address - Country:US
Mailing Address - Phone:907-347-8562
Mailing Address - Fax:907-451-6296
Practice Address - Street 1:3100 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7516
Practice Address - Country:US
Practice Address - Phone:907-347-8562
Practice Address - Fax:907-451-6296
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)