Provider Demographics
NPI:1184106502
Name:GILLIS, JANELLE (LCSW)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 GREENWAY DR STE 360
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2447
Mailing Address - Country:US
Mailing Address - Phone:346-584-4858
Mailing Address - Fax:
Practice Address - Street 1:1425 GREENWAY DR STE 360
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2447
Practice Address - Country:US
Practice Address - Phone:346-584-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-01
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0146071041C0700X
NCC0158581041C0700X
TX1107431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical