NPI 1013105295

Mary Gates-Gully, MSCADC

Practitioner Addiction (Substance Use Disorder) Counselor Centralia, IL

Practice location

Address: 904 E. Martin Luther King Drive, Centralia, IL 62801
Phone: (618) 533-1391
Fax: (618) 533-0012

Registered specialties

Addiction (Substance Use Disorder) Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YA0400X Licence 21816 (IL)

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Registry record

NPI: 1013105295
Entity type: Individual
Sex (as registered): Female
NPI issued: 12 Oct 2007
Record last updated: 7 Feb 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.