Provider Demographics
NPI:1164178760
Name:GILLIAM, CHELSEY (BA, MHP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:BA, MHP
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:GULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1660
Mailing Address - Country:US
Mailing Address - Phone:618-658-3079
Mailing Address - Fax:618-658-2501
Practice Address - Street 1:101 OLIVER ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1660
Practice Address - Country:US
Practice Address - Phone:618-658-3079
Practice Address - Fax:618-658-2501
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health