Provider Demographics
NPI:1316134646
Name:RILL, GLORIA JEANNE (MFTI)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEANNE
Last Name:RILL
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 ROBIN LN
Mailing Address - Street 2:STE 10
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8457
Mailing Address - Country:US
Mailing Address - Phone:530-672-1332
Mailing Address - Fax:530-672-1331
Practice Address - Street 1:3460 ROBIN LN
Practice Address - Street 2:STE 10
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8457
Practice Address - Country:US
Practice Address - Phone:530-672-1332
Practice Address - Fax:530-672-1331
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 47843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist