Provider Demographics
NPI:1043369176
Name:GILLIES, CHRISTINE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:L
Last Name:GILLIES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 HANCOCK ST STE 20
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-706-6744
Mailing Address - Fax:317-706-6700
Practice Address - Street 1:12337 HANCOCK ST STE 20
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5885
Practice Address - Country:US
Practice Address - Phone:317-706-6744
Practice Address - Fax:317-706-6700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003346103TC0700X
IN20043201A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGMedicaid