Provider Demographics
NPI:1841213840
Name:GILLILAND, MARCIE (MSED)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-0214
Mailing Address - Country:US
Mailing Address - Phone:509-334-0677
Mailing Address - Fax:509-334-3115
Practice Address - Street 1:1205 SE PROFESSIONAL MALL BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5423
Practice Address - Country:US
Practice Address - Phone:509-334-0677
Practice Address - Fax:509-334-3115
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health