Individual
MRS. CARISSA ELIZABETH GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., BCBA, LBA
Contact information
Practice address
2400 W DUNLAP AVE STE 100, PHOENIX, AZ 85021-2813
(602) 325-2485
Mailing address
4170 N 108TH AVE, PHOENIX, AZ 85037-5469
(480) 751-1957
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000496
AZ
Other
Enumeration date
02/05/2018
Last updated
11/29/2021
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