Mary Gates-Gully, MS, CADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

21816 Issued in IL

Practice address

904 E. Martin Luther King Drive
Centralia, IL 62801

Phone

(618) 533-1391

Fax

(618) 533-0012

NPI assigned

Oct 12, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517961600000",
    "number": "1013105295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 E. MARTIN LUTHER KING DRIVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "62801",
            "telephone_number": "618-533-1391",
            "fax_number": "618-533-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 E. MARTIN LUTHER KING DRIVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "62801",
            "telephone_number": "618-533-1391",
            "fax_number": "618-533-0012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "988 N Illinois Route 3",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IL",
            "postal_code": "622981000",
            "country_code": "US",
            "telephone_number": "618-939-4444",
            "fax_number": "618-939-4181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GATES-GULLY",
        "first_name": "MARY",
        "credential": "MS, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-12",
        "last_updated": "2018-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "21816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370915481007",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlee Fritsche
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• Nicole Garren, MSW
• Lindsay J. Garrison
• Eydie Gass
• Paige Gesell
• Mary Gibson-McNutt
• Kimberly Going, P.T.
• Athena A Gordon, M.S.
• Grand Prairie CCSD 6

• Addiction (Substance Use Disorder) Counselor in Centralia, IL
• Providers in Centralia, IL by specialty
• Addiction (Substance Use Disorder) Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.