Provider Demographics
NPI:1891937736
Name:GILLEY, HARRY ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ROBERT
Last Name:GILLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 FEDERAL DR APT C12
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1945
Mailing Address - Country:US
Mailing Address - Phone:618-889-0002
Mailing Address - Fax:
Practice Address - Street 1:2335 FEDERAL DR APT C12
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:618-889-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000056821041C0700X
IL1490079991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical