| Doctor Name: | MARY GATES-GULLY |
| NPI Number: | 1013105295 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CADC |
| License Number: | 21816 |
| Business Practice Address: | 988 N Illinois Route 3 Waterloo, IL - 622981000 |
| Business Phone Number: | 6189394444 |
| Business Fax Number: | 6189394181 |
| Mailing Address: | 988 N Illinois Route 3, Po Box 146 WATERLOO |
| State: | IL |
| Postal Code: | 622981000 |
| Phone Number: | 6189394444 |
| Fax Number: | 6189394181 |
| NPI Enumeration Date: | 10/12/2007 |
| NPI Last Update Date: | 10/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 21816 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |