Provider Demographics
NPI:1497975338
Name:GILLEN, LILLIE IDELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:IDELLA
Last Name:GILLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LILLIE
Other - Middle Name:GILLEN
Other - Last Name:HINKELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2006 CARTIER XING
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5632
Mailing Address - Country:US
Mailing Address - Phone:214-364-8658
Mailing Address - Fax:903-454-3307
Practice Address - Street 1:2405 STONEWALL ST STE 8
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-3349
Practice Address - Country:US
Practice Address - Phone:903-454-3300
Practice Address - Fax:903-454-3307
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5252Medicare PIN