Provider Demographics
NPI:1093074684
Name:SUSAN GENTZ GILLESPIE, LMFT
Entity Type:Organization
Organization Name:SUSAN GENTZ GILLESPIE, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GENTZ
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-609-8205
Mailing Address - Street 1:1250 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2603
Mailing Address - Country:US
Mailing Address - Phone:415-609-8205
Mailing Address - Fax:
Practice Address - Street 1:1250 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2603
Practice Address - Country:US
Practice Address - Phone:415-609-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLMFT000140251S00000X
CAMFT 38572251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health