Gayle P Nissen, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0904005220 Issued in VA

Practice address

1850 Cameron Glen Dr
Reston, VA 20190-3363

Phone

(703) 481-4011

Fax

(703) 481-1420

NPI assigned

Dec 8, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairfax County, Virginia

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fairfax, VA
  • NPI 1154356244

  DC

  Medicare reassignment
• Fairfax County, Virginia

  • Multi-Specialty Clinic/Center
  • Fairfax, VA
  • NPI 1174558266
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1982849782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 CAMERON GLEN DR",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903363",
            "telephone_number": "703-481-4011",
            "fax_number": "703-481-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 CAMERON GLEN DR",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903363",
            "telephone_number": "703-481-4011",
            "fax_number": "703-481-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "GAYLE",
        "middle_name": "P",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-08",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0904005220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99999",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas a Muss DDS
• Sandra Bruce Nichols, MD
• Richard A. Nicklas, M.D.
• Cordelia Nieketien-Tawari, DNP, APRN-BC. LNP
• Joshua Niekranz, PMHNP-BC
• Michael Ayuk Nkongho, PHARM. D
• Eduardo Christian Noguera, M.D.
• Ahmad Osman Noori, M.D.
• Ann Norman, LCSW
• North County Health Center

• Mental Health Counselor in Reston, VA
• Providers in Reston, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.