Provider Demographics
NPI:1679185755
Name:TIVON, GIL GERSHON (PHD)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:GERSHON
Last Name:TIVON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9851 W LONE CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0549
Mailing Address - Country:US
Mailing Address - Phone:520-788-1093
Mailing Address - Fax:
Practice Address - Street 1:9851 W LONE CACTUS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0549
Practice Address - Country:US
Practice Address - Phone:520-788-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral