MEDICARE: BRANDY GILLIHAN L.M.H.C.A

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	101YM0800X	Mental Health Counselor	MC60585602	WA

General Provider Information

NPI Number	:	1154792646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY GILLIHAN L.M.H.C.A

Provider Business Mailing Address
First Line	:	3200 CAPITAL MALL DR SW APT F302
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8790
Country	:	US
Telephone Number	:	360-350-9594
Fax Number	:

Provider Business Practice Location Address
First Line	:	673 WOODLAND SQUARE LOOP SE
Second Line	:	SUITE 330
City	:	LACEY
State	:	WA
Zip	:	98503-1066
Country	:	US
Telephone Number	:	888-364-9577
Fax Number	:	360-628-5240

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

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	10/09/2015

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