Provider Demographics
NPI:1184919839
Name:GILL, ANDREW (LPC-S, LCDC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 W WALNUT HILL LN STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3002
Mailing Address - Country:US
Mailing Address - Phone:817-360-5364
Mailing Address - Fax:817-977-8303
Practice Address - Street 1:1304 W WALNUT HILL LN STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3002
Practice Address - Country:US
Practice Address - Phone:817-360-5364
Practice Address - Fax:817-977-8303
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10377101YA0400X
TX62128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX262726999Medicaid