Provider Demographics
NPI:1720897739
Name:GILLAN, ELIZABETH JAYNE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JAYNE
Last Name:GILLAN
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 S LAMAR BLVD APT 2097
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0143
Mailing Address - Country:US
Mailing Address - Phone:214-335-6731
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DR STE 12
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4788
Practice Address - Country:US
Practice Address - Phone:214-335-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional