Provider Demographics
NPI:1942624580
Name:PATRICK EDWARD GILLILAND, LLC
Entity Type:Organization
Organization Name:PATRICK EDWARD GILLILAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:602-463-5673
Mailing Address - Street 1:9635 VENTANA WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8620
Mailing Address - Country:US
Mailing Address - Phone:678-366-8862
Mailing Address - Fax:678-739-0119
Practice Address - Street 1:9635 VENTANA WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8620
Practice Address - Country:US
Practice Address - Phone:678-366-8862
Practice Address - Fax:678-739-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty