| Doctor Name: | JASON GILLIAM |
| NPI Number: | 1083947832 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6802086046 |
| Business Practice Address: | 2280 E Grand River Ave Howell, MI - 488438503 |
| Business Phone Number: | 5175464126 |
| Business Fax Number: | 5175461300 |
| Mailing Address: | 2280 E Grand River Ave, HOWELL |
| State: | MI |
| Postal Code: | 488438503 |
| Phone Number: | 5175464126 |
| Fax Number: | 5175461300 |
| NPI Enumeration Date: | 09/11/2009 |
| NPI Last Update Date: | 09/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6802086046 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |