Individual
MRS. JESSICA ANN GILLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2022 W BLAYLOCK DR, PHOENIX, AZ 85085-1718
(602) 459-1709
Mailing address
2022 W BLAYLOCK DR, PHOENIX, AZ 85085-1718
(602) 459-1709
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC12819
AZ
Other
Enumeration date
07/02/2022
Last updated
07/02/2022
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