Provider Demographics
NPI:1760693220
Name:GILL, THOMAS P (PHD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:GILL
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 1:1248 PAPPANI DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3809
Mailing Address - Country:US
Mailing Address - Phone:408-843-8939
Mailing Address - Fax:
Practice Address - Street 1:1248 PAPPANI DR
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3809
Practice Address - Country:US
Practice Address - Phone:408-843-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist