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NPI Code Detail

MEDICARE: MARY GILLIAM-ANDRES M.A., L.L.P.C.

MEDICARE: MARY GILLIAM-ANDRES M.A., L.L.P.C.
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
1101YP2500XProfessional Counselor6401012360MI

General Provider Information

NPI Number : 1356626253
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY GILLIAM-ANDRES M.A., L.L.P.C.
Provider Business Mailing Address
First Line : 5675 FAIRVIEW ST
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-1033
Country : US
Telephone Number : 269-429-7727
Fax Number : 269-429-5754
Provider Business Practice Location Address
First Line : 5675 FAIRVIEW ST
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-1033
Country : US
Telephone Number : 269-429-7727
Fax Number : 269-429-5754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2011
Last Update Date : 10/12/2011

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