Basic Information
| Provider Information | |||||||||
| NPI: | 1831533116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILLUM | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | MS LPC CRADC CCDP-D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657752367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178187204 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1015 LANTON RD | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657753854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172562570 | ||||||||
| FaxNumber: | 4172656497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2007015287 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.