| Doctor Name: | MARK A GILLUM |
| NPI Number: | 1508033267 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 25600 Jayne Ave Coalinga, CA - 932101935 |
| Business Phone Number: | 5599354900 |
| Business Fax Number: | |
| Mailing Address: | 1077 Ross Way, HANFORD |
| State: | CA |
| Postal Code: | 932301935 |
| Phone Number: | 5595830866 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2008 |
| NPI Last Update Date: | 05/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |