Provider Demographics
NPI:1609143171
Name:GILLIAM COUNSELING AND DEVELOPMENT INC
Entity Type:Organization
Organization Name:GILLIAM COUNSELING AND DEVELOPMENT INC
Other - Org Name:DAYSPRING COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-570-9828
Mailing Address - Street 1:3317 FINLEY RD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-8722
Mailing Address - Country:US
Mailing Address - Phone:972-570-9828
Mailing Address - Fax:
Practice Address - Street 1:3317 FINLEY RD
Practice Address - Street 2:SUITE 168
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8722
Practice Address - Country:US
Practice Address - Phone:972-570-9828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9559101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty