MEDICARE: MRS. SARAH LYNN GILLIES MA, 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	1041C0700X	Clinical Social Worker	6401009870	MI
2	101YP2500X	Professional Counselor	6401009870	MI

General Provider Information

NPI Number	:	1851444335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH LYNN GILLIES MA, LPC

Provider Business Mailing Address
First Line	:	35000 DIVISION RD
Second Line	:	SUITE 2
City	:	RICHMOND
State	:	MI
Zip	:	48062-1566
Country	:	US
Telephone Number	:	586-727-5529
Fax Number	:	586-727-4922

Provider Business Practice Location Address
First Line	:	35000 DIVISION RD
Second Line	:	SUITE 2
City	:	RICHMOND
State	:	MI
Zip	:	48062-1566
Country	:	US
Telephone Number	:	586-727-5529
Fax Number	:	586-727-4922

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/27/2011

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