Provider Demographics
NPI:1750879607
Name:GILLIS, COURTNEY L (BCBA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:GILLIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:L
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48143-0663
Mailing Address - Country:US
Mailing Address - Phone:810-559-2129
Mailing Address - Fax:586-228-9902
Practice Address - Street 1:2890 CARPENTER RD STE 1100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:810-599-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst