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NPI Code Detail

MEDICARE: MRS. ANN MIGNON MATTINGLY GILLIS M.ED

MEDICARE: MRS. ANN MIGNON MATTINGLY GILLIS M.ED
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
1101YM0800XMental Health CounselorMH15063FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265663256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANN MIGNON MATTINGLY GILLIS M.ED
Provider Business Mailing Address
First Line : 1300 N PALAFOX ST
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-2664
Country : US
Telephone Number : 850-266-2724
Fax Number :
Provider Business Practice Location Address
First Line : 5642 JONES ST
Second Line :
City : MILTON
State : FL
Zip : 32570-2304
Country : US
Telephone Number : 850-626-7779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2009
Last Update Date : 05/29/2019

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