Individual
MICAH A GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2017042234
MO
101YP2500X
Professional Counselor
Primary
6401223314
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017042234
PLPC LICENSE
MO
05
—
490054503
—
MO
Enumeration date
12/13/2017
Last updated
07/12/2023
Update your record
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