1922538982 NPI number — MR. RODNEY C GILMORE CLINICAL COUNSELOR

Table of content: MR. RODNEY C GILMORE CLINICAL COUNSELOR (NPI 1922538982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922538982 NPI number — MR. RODNEY C GILMORE CLINICAL COUNSELOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILMORE
Provider First Name:
RODNEY
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL COUNSELOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922538982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 SW NYE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97365-3821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-574-5960
Provider Business Mailing Address Fax Number:
541-265-0601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SW LEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-574-5960
Provider Business Practice Location Address Fax Number:
541-265-0601
Provider Enumeration Date:
06/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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