Provider Demographics
NPI:1023231339
Name:GILLETT, CARL ROBERT (LPC, LMSW)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ROBERT
Last Name:GILLETT
Suffix:
Gender:M
Credentials:LPC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5800 EASTMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6815
Mailing Address - Country:US
Mailing Address - Phone:989-631-9145
Mailing Address - Fax:989-631-9145
Practice Address - Street 1:5800 EASTMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6815
Practice Address - Country:US
Practice Address - Phone:989-631-9145
Practice Address - Fax:989-631-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010346281041C0700X
MI6401000057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health