Provider Demographics
NPI:1942299011
Name:GILLESPIE, ROBERT DALE (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DALE
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:ROBERT
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:9865 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1344
Mailing Address - Country:US
Mailing Address - Phone:623-876-1246
Mailing Address - Fax:623-933-5463
Practice Address - Street 1:9865 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1344
Practice Address - Country:US
Practice Address - Phone:623-876-1246
Practice Address - Fax:623-933-5463
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10767101YA0400X
NMM-1878104100000X
AZLMFT-0256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist