Provider Demographics
NPI:1003023540
Name:GALLIMORE, MISTY LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 OLD FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-8401
Mailing Address - Country:US
Mailing Address - Phone:931-762-6505
Mailing Address - Fax:
Practice Address - Street 1:1090 OLD FLORENCE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-8401
Practice Address - Country:US
Practice Address - Phone:931-762-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)