Provider Demographics
NPI:1437717451
Name:JOANNA L GILLIS
Entity Type:Organization
Organization Name:JOANNA L GILLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:LESLI
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-896-8427
Mailing Address - Street 1:PO BOX 10655
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3655
Mailing Address - Country:US
Mailing Address - Phone:310-896-8427
Mailing Address - Fax:310-268-1015
Practice Address - Street 1:2080 CENTURY PARK E STE 1406
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2017
Practice Address - Country:US
Practice Address - Phone:310-896-8427
Practice Address - Fax:310-268-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66593OtherLICENSE NUMBER