Healthcare Provider Details

I. General information

NPI: 1730161225
Provider Name (Legal Business Name): PATRICIA A GILLETTE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/08/2023
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 S FIFTH STREET
TUCSON AZ
85707-6004
US

IV. Provider business mailing address

3515 S 5TH ST
TUCSON AZ
85743
US

V. Phone/Fax

Practice location:
  • Phone: 520-451-2232
  • Fax:
Mailing address:
  • Phone: 520-451-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number5255
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5525
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5525
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5525
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: