Provider Demographics
NPI:1366089443
Name:GILLIGAN NUTRITION COUNSELING LLC
Entity type:Organization
Organization Name:GILLIGAN NUTRITION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RDN
Authorized Official - Phone:314-537-0932
Mailing Address - Street 1:10104 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1240
Mailing Address - Country:US
Mailing Address - Phone:314-537-0932
Mailing Address - Fax:
Practice Address - Street 1:10104 CONWAY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1240
Practice Address - Country:US
Practice Address - Phone:314-537-0932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service