Provider Demographics
NPI:1912298910
Name:ZILLI, GARY JOSEPH (MA GUIDANCE & COUNSE)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:JOSEPH
Last Name:ZILLI
Suffix:
Gender:M
Credentials:MA GUIDANCE & COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29567 EIFFEL
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:586-573-7828
Mailing Address - Fax:
Practice Address - Street 1:20811 KELLY ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-445-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC-00924OtherCAADC