1386826667 NPI number — HOLISTIC THERAPEUTICS OF GAINESVILLE LLC

Table of content: MRS. PAMELA SUZANNE GILLEY LCSW (NPI 1851001473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386826667 NPI number — HOLISTIC THERAPEUTICS OF GAINESVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC THERAPEUTICS OF GAINESVILLE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386826667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 W NEWBERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32607-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-359-5667
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 W NEWBERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-359-5667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOENBORN
Authorized Official First Name:
SANDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-359-5667

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  8189 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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