Provider Demographics
NPI:1174189971
Name:GILLES, ERIC HAMILTON
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:HAMILTON
Last Name:GILLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18627 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7057
Mailing Address - Country:US
Mailing Address - Phone:714-852-2363
Mailing Address - Fax:
Practice Address - Street 1:1231 E DYER RD STE 135
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5643
Practice Address - Country:US
Practice Address - Phone:714-659-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor