Provider Demographics
NPI:1235294802
Name:GILLEN, WILLIAM GARVER (PHD LCPC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARVER
Last Name:GILLEN
Suffix:
Gender:M
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1770 EAST LAKESHORE DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521
Mailing Address - Country:US
Mailing Address - Phone:217-428-0600
Mailing Address - Fax:217-428-7581
Practice Address - Street 1:1770 EAST LAKESHORE DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521
Practice Address - Country:US
Practice Address - Phone:217-428-0600
Practice Address - Fax:217-428-7581
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional