Basic Information
| Provider Information | |||||||||
| NPI: | 1679856041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | C. | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | LPC | ||||||||
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| OtherLastName: | GILL | ||||||||
| OtherFirstName: | CHRIS | ||||||||
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| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 509 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674012353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858250541 | ||||||||
| FaxNumber: | 7858250062 | ||||||||
| Practice Location | |||||||||
| Address1: | 7320 S YALE AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184880163 | ||||||||
| FaxNumber: | 9184881583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2011 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1635 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.