Provider Demographics
NPI:1467799593
Name:GILL, ERIC JASON (MSM, MDIV)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JASON
Last Name:GILL
Suffix:
Gender:M
Credentials:MSM, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10819 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-2121
Mailing Address - Country:US
Mailing Address - Phone:405-410-4474
Mailing Address - Fax:
Practice Address - Street 1:11032 QUAIL CREEK RD.
Practice Address - Street 2:STE. 265
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-751-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health