Provider Demographics
NPI:1033447107
Name:GILL, SALLY (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 N. JONES BLVD
Mailing Address - Street 2:#753442
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-3442
Mailing Address - Country:US
Mailing Address - Phone:702-625-3205
Mailing Address - Fax:
Practice Address - Street 1:8414 FARM RD
Practice Address - Street 2:STE 180 - 1036
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8913
Practice Address - Country:US
Practice Address - Phone:702-625-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist