Active NPI
Timothy Gillis, LPC, LPCS, MAC, CDCI
- Professional Counselor
- Kenai, AK
National Provider Identifier
1154639763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 624
- Practice address
- 110 N Willow St
Kenai, AK 99611-7701 - Phone
- (907) 398-0524
- Fax
- (888) 678-2961
- NPI assigned
- Sep 16, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 624 | AK | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 508906 | AK |
Addresses
Primary practice location
110 N Willow St
Kenai, AK 99611-7701
Mailing address
PO Box 1692
Kenai, AK 99611-1692
Phone (907) 398-0524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 508906 | AK | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485734400000",
"number": "1154639763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1692",
"city": "KENAI",
"state": "AK",
"postal_code": "996111692",
"telephone_number": "907-398-0524",
"fax_number": "888-678-2961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 N WILLOW ST",
"city": "KENAI",
"state": "AK",
"postal_code": "996117701",
"telephone_number": "907-398-0524",
"fax_number": "888-678-2961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "TIMOTHY",
"credential": "LPC, LPCS, MAC, CDCI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-16",
"last_updated": "2017-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AK",
"license": "624",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AK",
"license": "508906",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenai, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.