| Doctor Name: | DR. MARK CLIFFORD GILLEN |
| NPI Number: | 1104830785 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 913-125 |
| Business Practice Address: | 257 N Piety St Ellsworth, WI - 540115056 |
| Business Phone Number: | 7154253890 |
| Business Fax Number: | |
| Mailing Address: | 257 N Piety St, ELLSWORTH |
| State: | WI |
| Postal Code: | 540115056 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 913-125 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |