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NPI Code Detail

MEDICARE: STEPHANIE GILLIS LMFT

MEDICARE: STEPHANIE GILLIS LMFT
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
1106H00000XMarriage & Family Therapist556KY
2106H00000XMarriage & Family Therapist35001677AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000608641OTHERINANTHEM

General Provider Information

NPI Number : 1861525230
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GILLIS LMFT
Provider Business Mailing Address
First Line : 4925 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-9426
Country : US
Telephone Number : 812-941-9200
Fax Number : 812-941-9205
Provider Business Practice Location Address
First Line : 4925 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-9426
Country : US
Telephone Number : 812-941-9200
Fax Number : 812-941-9205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 06/28/2016

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