Provider Demographics
NPI:1154182491
Name:DR KELSEY L GILLEON PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:DR KELSEY L GILLEON PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-771-6717
Mailing Address - Street 1:111 N HIGGINS AVE STE 204S
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4401
Mailing Address - Country:US
Mailing Address - Phone:406-868-8315
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGGINS AVE STE 204S
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4401
Practice Address - Country:US
Practice Address - Phone:406-868-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty