Provider Demographics
NPI:1942983127
Name:GILLESPIE, JUSTIN (APCC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:APCC
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 28265
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-8265
Mailing Address - Country:US
Mailing Address - Phone:650-885-6550
Mailing Address - Fax:
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5698
Practice Address - Country:US
Practice Address - Phone:650-297-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health