| Doctor Name: | MS. LYNN GILLIS |
| NPI Number: | 1043631450 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., L.C.P.C. |
| License Number: | SWP-LCPC-LIC-4562 |
| Business Practice Address: | 24276 166th Se Airport Road Eagle Butte, SD - 57625 |
| Business Phone Number: | 6059640742 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1711, EAGLE BUTTE |
| State: | SD |
| Postal Code: | 576251711 |
| Phone Number: | 6059640742 |
| Fax Number: | |
| NPI Enumeration Date: | 01/02/2014 |
| NPI Last Update Date: | 01/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | SWP-LCPC-LIC-4562 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |