MEDICARE: DR. SALLY GILL PHD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	01226	NV

General Provider Information

NPI Number	:	1033447107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY GILL PHD, MS

Provider Business Mailing Address
First Line	:	6210 N. JONES BLVD
Second Line	:	#753442
City	:	LAS VEGAS
State	:	NV
Zip	:	89136-3442
Country	:	US
Telephone Number	:	702-625-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	8414 FARM RD
Second Line	:	STE 180 - 1036
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8913
Country	:	US
Telephone Number	:	702-625-3205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	01/15/2021

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