Provider Demographics
NPI:1649335878
Name:GILNER, MAXINE W (PHD)
Entity type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:W
Last Name:GILNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6320
Mailing Address - Country:US
Mailing Address - Phone:314-966-5631
Mailing Address - Fax:314-835-1172
Practice Address - Street 1:620 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6320
Practice Address - Country:US
Practice Address - Phone:314-966-5631
Practice Address - Fax:314-835-1172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO300014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO300014OtherSTATE LICENSE NUMBER