Provider Demographics
NPI:1669132023
Name:GNILKA, PHILIP BRANSFORD
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BRANSFORD
Last Name:GNILKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 W POST RD STE 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6646
Mailing Address - Country:US
Mailing Address - Phone:702-329-0546
Mailing Address - Fax:
Practice Address - Street 1:7318 W POST RD STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-6646
Practice Address - Country:US
Practice Address - Phone:702-329-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010755101YP2500X
NVCP5475-R101YP2500X
GALPC008584101YP2500X
CALPCC11502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional