Provider Demographics
NPI:1003536483
Name:GILPIN, PATRICIA (RN, LAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GILPIN
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S HALSTED DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1555
Mailing Address - Country:US
Mailing Address - Phone:480-709-9184
Mailing Address - Fax:
Practice Address - Street 1:8350 E RAINTREE DR STE 245
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2694
Practice Address - Country:US
Practice Address - Phone:623-349-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional