Provider Demographics
NPI:1912642208
Name:GILEAD TELEPSYCH, LLC
Entity Type:Organization
Organization Name:GILEAD TELEPSYCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAGDALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPIE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:240-551-3447
Mailing Address - Street 1:6908 STRATHMORE ST APT 316
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 VICKSBURG AVE APT M2
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-2479
Practice Address - Country:US
Practice Address - Phone:405-310-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILEAD TELEHEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200898000AMedicaid