MARY GATES-GULLY (NPI# 1013105295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013105295 |
| Entity Type | Individual |
| Full Name | MARY GATES-GULLY |
| Credential | MS, CADC |
| Practice Address |
904 E. Martin Luther King Drive Centralia IL 62801 |
| Practice Telephone | 6185331391 |
| Practice Fax Number | 6185330012 |
| Mailing Telephone | 6185331391 |
| Mailing Fax Number | 6185330012 |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2018-02-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
21816 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 370915481007 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 988 N Illinois Route 3, Waterloo, IL 622981000 | 6189394444 | 6189394181 |
| Street Address |
904 E. MARTIN LUTHER KING DRIVE |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780762815 | Melissa Aberg West | Psychiatry & Neurology | 904 E. Martin Luther King Drive, Centralia, IL 62801 | 2006-11-02 |
| 1316509615 | Alayna Moore | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2019-07-08 |
| 1598239998 | Dawn Martinez-uribe | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2019-01-18 |
| 1720560808 | Paula Armstrong | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801 | 2018-09-05 |
| 1417437211 | Kurtiss Hassebrock | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2018-08-21 |
| 1144700980 | Linda Hanna | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2018-08-21 |
| 1457831299 | Nadia Riazati | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2018-08-21 |
| 1316431331 | Adam Borges | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2018-06-22 |
| 1720571342 | Brittany Brown | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2018-06-08 |
| 1326540121 | Wendy Suey | Counselor | 904 E. Martin Luther King Drive, Centralia, IL 62801-3058 | 2018-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477113041 | Cortney Nicole Jensen | Counselor | 1611 Kresky Ave Ste 114, Centralia, WA 98531-8982 | 2019-06-17 |
| 1831629476 | Chad Eric Holmes | Counselor | 1616 S. Gold St. #4, Centralia, WA 98531-0001 | 2017-06-15 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1932447745 | Amanda Winchell | Counselor | 904 Mlk Dr, Centralia, IL 62801 | 2013-01-29 |
| 1508098930 | Jessica Lynn Stickley | Counselor | 1641 Kresky Ave, Centralia, WA 98531 | 2009-08-18 |
| 1003037557 | Travis Merrell Trone I | Counselor | 628 Tracy Ter, Centralia, IL 62801-4478 | 2007-05-01 |
| 1710539747 | Esther V Lloyd | Counselor | 1611 Kresky Ave Ste 114, Centralia, WA 98531 | 2019-07-10 |
| 1700359411 | Tonja Evonne Vernon | Counselor | 1723 Kresky Ave, Centralia, WA 98531-8985 | 2019-01-04 |
| 1225515844 | Ann Marie Shoddy | Counselor | 1616 S Gold St Ste 4, Centralia, WA 98531-8930 | 2018-07-26 |
| 1639656275 | Antoinette Kathleen Smith | Counselor | 1616 S Gold St Ste 4, Centralia, WA 98531-8930 | 2018-07-26 |
| Find all providers in CENTRALIA | ||||
Please comment or provide details below to improve the information on MARY GATES-GULLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.