Provider Demographics
NPI:1336837152
Name:GILLARD, EMILY (LPCA, MED)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GILLARD
Suffix:
Gender:F
Credentials:LPCA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20970 KING HEZEKIAH WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2849
Mailing Address - Country:US
Mailing Address - Phone:503-481-5795
Mailing Address - Fax:
Practice Address - Street 1:20970 KING HEZEKIAH WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2849
Practice Address - Country:US
Practice Address - Phone:503-481-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health