Provider Demographics
NPI:1649932997
Name:MCGILLIS, KAYLEE ELIZABETH
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ELIZABETH
Last Name:MCGILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DANIEL RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1411
Mailing Address - Country:US
Mailing Address - Phone:508-322-8182
Mailing Address - Fax:
Practice Address - Street 1:6 DANIEL RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1411
Practice Address - Country:US
Practice Address - Phone:508-322-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health