Provider Demographics
NPI:1790029338
Name:GILSON, ALLISON N (PHD, LP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:N
Last Name:GILSON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8834 E 34 RD # 131 SMB 14146
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9580
Mailing Address - Country:US
Mailing Address - Phone:734-472-2705
Mailing Address - Fax:734-666-3873
Practice Address - Street 1:44050 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1904
Practice Address - Country:US
Practice Address - Phone:734-472-2705
Practice Address - Fax:734-666-3873
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012039121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical