Provider Demographics
NPI:1588726764
Name:GILLAM, RACHEL ANN (BS)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:GILLAM
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:GILLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:717 E CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-6105
Mailing Address - Country:US
Mailing Address - Phone:713-775-3736
Mailing Address - Fax:
Practice Address - Street 1:7080 N MARKS AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0288
Practice Address - Country:US
Practice Address - Phone:559-248-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor