Provider Demographics
NPI:1588003883
Name:GILLILAND, MAGGIE RYAN (LMLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:RYAN
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24208 Q RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8484
Mailing Address - Country:US
Mailing Address - Phone:785-304-3583
Mailing Address - Fax:
Practice Address - Street 1:902 S. 2ND STREET
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434
Practice Address - Country:US
Practice Address - Phone:785-742-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS774103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist