Provider Demographics
NPI:1548602048
Name:GILLAN, SHELLY A (LMFT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:A
Last Name:GILLAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 CLARA DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4001
Mailing Address - Country:US
Mailing Address - Phone:650-208-6564
Mailing Address - Fax:
Practice Address - Street 1:457 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3222
Practice Address - Country:US
Practice Address - Phone:650-208-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist