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NPI Code Detail

MEDICARE: MR. DAVID J GILLIS

MEDICARE: MR. DAVID J GILLIS
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 CounselorCP5298NV

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 : 1811308976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID J GILLIS
Provider Business Mailing Address
First Line : 1901 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1260
Country : US
Telephone Number : 702-219-7968
Fax Number :
Provider Business Practice Location Address
First Line : 1901 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1260
Country : US
Telephone Number : 702-219-7968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2014
Last Update Date : 11/04/2025

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