MEDICARE: EVE GILLAN SELF MS, LPC

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	2748	MS

General Provider Information

NPI Number	:	1487337317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE GILLAN SELF MS, LPC

Provider Business Mailing Address
First Line	:	2124 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3937
Country	:	US
Telephone Number	:	601-436-9514
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3937
Country	:	US
Telephone Number	:	601-436-9514
Fax Number	:

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

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	09/18/2025

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