Individual
BETHANY GILLILAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
340 HWY 138, CRESTLINE, CA 92326
(909) 273-7714
Mailing address
PO BOX 6300, CRESTLINE, CA 92325-6300
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APCC18605
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/28/2023
Last updated
02/19/2025
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