Provider Demographics
NPI:1568588325
Name:GILLIS, RUTH ANNE (MC MFT)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANNE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MC MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9338 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2424
Mailing Address - Country:US
Mailing Address - Phone:619-341-3747
Mailing Address - Fax:619-341-4737
Practice Address - Street 1:1250 6TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4368
Practice Address - Country:US
Practice Address - Phone:619-515-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5979OtherSAN DIEGO COUNTY #