Provider Demographics
NPI:1861129694
Name:GILLIES, PATRICK IRWIN (LPC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:IRWIN
Last Name:GILLIES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2332
Mailing Address - Country:US
Mailing Address - Phone:734-639-2262
Mailing Address - Fax:
Practice Address - Street 1:PATRICK GILLIES
Practice Address - Street 2:750 SOUTH MONROE ST
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1430
Practice Address - Country:US
Practice Address - Phone:734-639-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401224389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional