| Doctor Name: | MR. BRUCE E GILLETTE |
| NPI Number: | 1053578005 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC |
| License Number: | 1378 |
| Business Practice Address: | 300 13th Ave W Ste 1 Dickinson, ND - 586014875 |
| Business Phone Number: | 7012277580 |
| Business Fax Number: | 7012277575 |
| Mailing Address: | 300 13th Ave W Ste 1, DICKINSON |
| State: | ND |
| Postal Code: | 586014875 |
| Phone Number: | 7012277580 |
| Fax Number: | 7012277575 |
| NPI Enumeration Date: | 05/19/2008 |
| NPI Last Update Date: | 11/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1378 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |