Healthcare Provider Details

I. General information

NPI: 1093108748
Provider Name (Legal Business Name): REBECCA GILLIS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GRAND AVE BLDG 27
SAN LUIS OBISPO CA
93407-9000
US

IV. Provider business mailing address

1 GRAND AVE BLDG 27
SAN LUIS OBISPO CA
93407-9000
US

V. Phone/Fax

Practice location:
  • Phone: 805-756-1211
  • Fax:
Mailing address:
  • Phone: 805-756-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: