Provider Demographics
NPI:1669358123
Name:GILLISPIE, HANNAH MAKENZIE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MAKENZIE
Last Name:GILLISPIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 W EULESS BLVD STE 15
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4437
Mailing Address - Country:US
Mailing Address - Phone:682-704-6690
Mailing Address - Fax:469-589-1770
Practice Address - Street 1:831 W EULESS BLVD STE 15
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-4437
Practice Address - Country:US
Practice Address - Phone:682-704-6690
Practice Address - Fax:469-589-1770
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-322057106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician