| Doctor Name: | TIMOTHY GILLIS |
| NPI Number: | 1154639763 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LPC |
| License Number: | 624 |
| Business Practice Address: | 44175 K Beach Rd Soldotna, AK - 996698239 |
| Business Phone Number: | 9073980524 |
| Business Fax Number: | |
| Mailing Address: | 45083 Nola St, KENAI |
| State: | AK |
| Postal Code: | 996119757 |
| Phone Number: | 9073980524 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2010 |
| NPI Last Update Date: | 09/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 624 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |