Provider Demographics
NPI:1013645308
Name:GILLS, TORI KELLEEN (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:TORI
Middle Name:KELLEEN
Last Name:GILLS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 REPECHO DR APT 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1708
Mailing Address - Country:US
Mailing Address - Phone:907-350-0317
Mailing Address - Fax:
Practice Address - Street 1:5445 REPECHO DR APT 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1708
Practice Address - Country:US
Practice Address - Phone:907-350-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-60865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst