Provider Demographics
NPI:1083354013
Name:GILLESPIE, EMORY (MDIV MA)
Entity Type:Individual
Prefix:
First Name:EMORY
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MDIV MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4121
Mailing Address - Country:US
Mailing Address - Phone:319-481-7572
Mailing Address - Fax:
Practice Address - Street 1:2410 35TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4121
Practice Address - Country:US
Practice Address - Phone:319-481-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional