Provider Demographics
NPI:1578653580
Name:GILLIES, SHAWN A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:A
Last Name:GILLIES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5628
Mailing Address - Country:US
Mailing Address - Phone:253-880-3053
Mailing Address - Fax:
Practice Address - Street 1:815 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5628
Practice Address - Country:US
Practice Address - Phone:253-880-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60045752106H00000X
UT51577723902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist