Basic Information
| Provider Information | |||||||||
| NPI: | 1497906689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | MILLER | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7945 STONE CREEK DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553174606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743999 | ||||||||
| FaxNumber: | 9529743780 | ||||||||
| Practice Location | |||||||||
| Address1: | 7945 STONE CREEK DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553174606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5299743999 | ||||||||
| FaxNumber: | 9529743780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1813 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1497906689 | 05 | MN | MEDICAID |