Provider Demographics
NPI:1578216891
Name:JOANNA GILLIS LICENSED CLINICAL SOCIAL WORKER GILLIS THERAPY GROUP INC
Entity Type:Organization
Organization Name:JOANNA GILLIS LICENSED CLINICAL SOCIAL WORKER GILLIS THERAPY GROUP INC
Other - Org Name:GILLIS THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-394-0312
Mailing Address - Street 1:2080 CENTURY PARK E STE 1406
Mailing Address - Street 2:
Mailing Address - City:CENTURY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2017
Mailing Address - Country:US
Mailing Address - Phone:424-394-0295
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1406
Practice Address - Street 2:
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067-2017
Practice Address - Country:US
Practice Address - Phone:424-394-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty