Provider Demographics
NPI:1881779775
Name:GILLILAND, EDWARD WILLIAM (RELD/ DMIN)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:RELD/ DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CHAMBERS
Mailing Address - Street 2:SUITE 5 P.O. BOX 3303
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-3303
Mailing Address - Country:US
Mailing Address - Phone:970-328-1503
Mailing Address - Fax:970-328-3302
Practice Address - Street 1:850 CHAMBERS
Practice Address - Street 2:SUITE 5
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-3303
Practice Address - Country:US
Practice Address - Phone:970-328-1503
Practice Address - Fax:970-328-3302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist