Provider Demographics
NPI:1396285474
Name:GILLEY, THOMAS (LCPC-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:GILLEY
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:STEEP FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04085-6001
Mailing Address - Country:US
Mailing Address - Phone:207-252-9000
Mailing Address - Fax:
Practice Address - Street 1:5 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6418
Practice Address - Country:US
Practice Address - Phone:207-252-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health