Provider Demographics
NPI:1528169356
Name:GILLESPY, SUSAN J (LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:GILLESPY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 CENTURION PKWY
Mailing Address - Street 2:# 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0579
Mailing Address - Country:US
Mailing Address - Phone:904-403-8067
Mailing Address - Fax:
Practice Address - Street 1:7545 CENTURION PKWY
Practice Address - Street 2:# 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0579
Practice Address - Country:US
Practice Address - Phone:904-403-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist