Provider Demographics
NPI:1407964117
Name:GILL, SANDRA S (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ROUND ROCK WEST DR
Mailing Address - Street 2:SUITE 606
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5007
Mailing Address - Country:US
Mailing Address - Phone:512-632-2125
Mailing Address - Fax:512-671-9415
Practice Address - Street 1:6000 S. MOPAC EXPRESSWAY, SUITE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-7866
Practice Address - Country:US
Practice Address - Phone:512-244-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000050881041C0700X
TX328241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162837207Medicaid
TX327042YL5EMedicare PIN
TX327042YL9JMedicare PIN
TX162837205Medicaid