Provider Demographics
NPI:1235389685
Name:PILLAI, GOPAN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GOPAN
Middle Name:
Last Name:PILLAI
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 INTERNATIONAL PKWY STE 2100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8228
Mailing Address - Country:US
Mailing Address - Phone:972-757-4150
Mailing Address - Fax:
Practice Address - Street 1:6404 INTERNATIONAL PKWY STE 2100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8228
Practice Address - Country:US
Practice Address - Phone:972-757-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704421363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207163101Medicaid
812N81OtherBLUE CROSS BLUE SHIELD
8L18868Medicare PIN