Gates-Gully, Mary

Gates-Gully, Mary is an individual health care provider with primary practice located at 904 E. Martin Luther King Drive , Centralia IL 62801. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Gates-Gully, Mary can be contacted via phone (618) 533-1391.

Contact Information

Primary practice address
904 E. Martin Luther King Drive Centralia IL 62801
Phone: (618) 533-1391
Fax: (618) 533-0012
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 21816 Illinois

Profile Details

NPI number 1013105295
LBN Legal business name Gates-Gully, Mary
Credentials MS, CADC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2007
Last updated Feb 7th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013105295 NPPES
Illinois MEDICAID 370915481007

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