Provider Demographics
NPI:1851702252
Name:GILLISPIE COUNSELING SERVICES
Entity Type:Organization
Organization Name:GILLISPIE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLISPIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-437-4497
Mailing Address - Street 1:23 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4601
Mailing Address - Country:US
Mailing Address - Phone:405-437-4497
Mailing Address - Fax:855-253-2083
Practice Address - Street 1:23 N 8TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4601
Practice Address - Country:US
Practice Address - Phone:580-606-6577
Practice Address - Fax:855-253-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5018251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200539560Medicaid