Provider Demographics
NPI:1184856858
Name:GILLIS, LAUREN (LPC,LMHC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LPC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 COTTAGE COVE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5965
Mailing Address - Country:US
Mailing Address - Phone:518-578-1014
Mailing Address - Fax:843-390-2379
Practice Address - Street 1:2200 PREMIER RESORT BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-9203
Practice Address - Country:US
Practice Address - Phone:518-578-1014
Practice Address - Fax:843-390-2379
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor