Provider Demographics
NPI:1215576418
Name:GILLEY, MARTHA M (LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:GILLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:M
Other - Last Name:DOOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:598 SE DD HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-8406
Mailing Address - Country:US
Mailing Address - Phone:816-514-4455
Mailing Address - Fax:660-362-1332
Practice Address - Street 1:598 SE DD HWY STE 1
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-8406
Practice Address - Country:US
Practice Address - Phone:816-514-4455
Practice Address - Fax:660-362-1332
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019043569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health