Healthcare Provider Details

I. General information

NPI: 1265010151
Provider Name (Legal Business Name): JOANNA GILLIAM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 RATTANA CT
WESLEY CHAPEL FL
33545-1364
US

IV. Provider business mailing address

30150 RATTANA CT
WESLEY CHAPEL FL
33545-1364
US

V. Phone/Fax

Practice location:
  • Phone: 813-602-2969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: